This past week, the international development and global health community has been torn apart by a debate about parasitic worms that has grown so fierce it's been dubbed the "worm wars." The dispute became so heated that it achieved escape velocity and jumped from the academic Twittersphere to the mainstream press, with coverage in the Guardian, BuzzFeed News, and elsewhere.
Within the academic community, it's a fight over the validity of an academic study suggesting that distributing pills to kill intestinal worms would not just improve health but also have all sorts of knock-on effects such as improving education. But the reason this has caught mainstream attention is that the worm wars are threatening one of the holy grails of international development: the idea that somewhere out there is a simple, easy intervention that will have a huge positive effect on a complex, difficult problem.
In this case, the simple intervention was deworming medication: Handing out cheap, safe pills is pretty easy. And the complex problem was how to improve education for poor kids. The paper that’s now under dispute concluded that giving Kenyan schoolchildren deworming pills improved their educational outcomes as well as the educational outcomes for other kids in neighboring schools who didn’t even get the medication. It seemed like the world had stumbled onto an actual magic pill.
Deworming became a cause célèbre. In 2008 Cherie Blair, then the wife of former British Prime Minister Tony Blair, even dressed up as a giant intestinal worm and chased down Davos attendees to raise awareness of the issue. (Sadly, photos of that event appear to have been lost to the depths of the broken-internet-link abyss.) The Copenhagen Consensus's expert panel, which included four Nobel laureates, proclaimed deworming to be one of the four most important health initiatives on earth. They estimated that deworming programs would produce economic benefits 10 times greater than their costs.
But then came the worm wars, and the miracle pill started to look less miraculous. While there had been questions for years about whether de-worming's miraculous effects were really supported by good evidence, the debate exploded into the full-fledged "war" just recently, when other researchers tried to replicate the original paper’s findings. They concluded that some of the data was flawed or incomplete, and that the original paper's most exciting findings about deworming’s miraculous effects on education melted away under the new analysis. In other words, they suggested that this easy solution to a hard problem wasn’t an easy solution after all.
There is, to be clear, still an ongoing debate over the degree to which the original paper's findings were or were not valid, and what this means for the case for deworming. But the fact that deworming initiatives are being judged on whether they can be proven to have near-sorcerous effects on poverty shows that this is much more than just a dispute over academic methods.
There’s a lesson here, but it’s not one we’re going to like. Everyone likes easy solutions to hard problems. But when we become too focused on finding them, we lose sight of the truth: that the most effective solutions are often complex and difficult to implement.
This is a problem that has played out again and again in international development: We look for those easy solutions as a way to ignore the hard ones, and end up going down the wrong paths.
It’s not just deworming; there are plenty of other examples: Thursday I wrote about the problems with the popular theory that distributing menstrual pads to poor girls helps their educational outcomes. And there was a similar impulse behind the school-building programs in Afghanistan and Pakistan run by now-disgraced Three Cups of Tea author Greg Mortenson: that the relatively easy act of building some schools would not only improve education for rural kids, but help end war and terrorism in one of the most volatile regions of the world.
What all those solutions have in common is that they promised to solve complex problems that have their roots in even larger problems such as broken institutions or counterproductive behavior, without doing the complex work of actually improving institutions or changing behavior.
Building a school in Afghanistan doesn’t necessarily improve education — you almost certainly need to address things like social norms and national institutions to have a real impact — much less improve the Afghan war that is the real problem. Giving girls menstrual pads is a kind and generous thing to do, but improving their education often means making difficult changes to everything from school facilities to social norms around puberty and menstruation. And while deworming children is a great way to treat an unpleasant and damaging health problem, really improving education or ending poverty requires much more than a magic pill.
The truth is that solving hard problems almost always requires hard solutions. That sounds obvious. But the ferocity of the worm wars debate goes to show that it's a lesson the global development community, in its obsession with finding a magic fix for poverty that probably does not exist, can easily forget.