Vox: All Posts by Miranda Dixon-Luinenburghttps://cdn.vox-cdn.com/community_logos/52517/voxv.png2023-07-09T07:00:00-04:00https://www.vox.com/authors/miranda-dixon-luinenburg/rss2023-07-09T07:00:00-04:002023-07-09T07:00:00-04:00How abortion bans will strain an already failing foster system
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<img alt="An illustration of a large eye peeking through a window into a family’s home, where laundry and overdue bills are strewn. In a shadowy corner, a mother stands holding her child, appearing to hide from the eye." src="https://cdn.vox-cdn.com/thumbor/qGicuX09A3f6bkS0Wt95RUEoyJY=/240x0:1680x1080/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72437004/Vox_FamilySeparation_PaigeVickers.0.jpg" />
<figcaption>Paige Vickers/Vox</figcaption>
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<p>Poor families are more likely to be separated by the government. The Dobbs decision will make it worse.</p> <p id="qTx20X">When Michael’s mother called Maine’s primary welfare assistance hotline asking for help, she was a depressed and homeless 18-year-old single mother of three. It was the winter of 1996, and her boyfriend — her last source of additional support — had left her. </p>
<p id="XQ5NQ3">A social worker with Maine’s Child Protective Services offered assistance with finding an apartment, but there was a catch — Michael’s mother had to agree that her young children would be taken into foster care. In the state’s eyes, her poverty meant she didn’t have the resources to take care of her kids. But perhaps they could be reunited once she became more stable.</p>
<p id="MIvndX">This never happened. </p>
<p id="sKmIGd">Michael was 4 years old when he entered the foster care system. It took five years for him to meet Mary Callahan, the foster carer who eventually adopted him. </p>
<p id="4O5S4t">At first, Michael blamed his birth mother (whose name isn’t shared for privacy) for what happened — not because he felt she had neglected or abused him, but because she asked for help, and set off the process that would tear their lives apart. </p>
<p id="UpQGgt">“It took him a long, long time to get over being angry that she’s the one who made the phone call,” Callahan said. </p>
<p id="nBDGNJ">Raising children in the US on a low income is already incredibly difficult, and parents have <a href="https://www.americanprogress.org/article/weak-safety-net-policies-exacerbate-regional-racial-inequality/">limited support</a> from social safety net programs. Single <a href="https://datacenter.aecf.org/data/tables/55-families-with-related-children-that-are-below-poverty-by-family-type?loc=1&loct=2#detailed/2/2-53/true/2048/994,1297,4240/346">parents</a>, <a href="https://www.clasp.org/sites/default/files/public/resources-and-publications/publication-1/0090.pdf">teen</a> parents, and <a href="https://www.cbpp.org/research/income-security/improvements-in-tanf-cash-benefits-needed-to-undo-the-legacy-of-historical">families of color</a> face particular disadvantages; states with high Black populations <a href="https://ncpolicywatch.com/2021/08/05/new-and-damning-report-black-women-with-children-excluded-from-federal-cash-assistance-program/">tend to have</a> the weakest <a href="https://www.cbpp.org/blog/despite-recent-tanf-benefit-boosts-black-families-left-behind">social assistance</a> programs, and welfare <a href="https://washingtonmonthly.com/2021/04/17/welfare-work-requirements-have-to-go/">work requirements</a> can trap parents in low-paying <a href="https://www.vox.com/labor-jobs" data-source="encore">jobs</a>. Cash welfare benefits through the <a href="https://www.acf.hhs.gov/ofa/programs/temporary-assistance-needy-families-tanf">Temporary Assistance for Needy Families</a> (TANF) program, which provides cash payments and other services to low-income families with children, are often <a href="https://nwlc.org/wp-content/uploads/2016/11/TANF-Child-Care-Fact-Sheet-11.4.16.pdf">insufficient</a> to cover child care expenses. Nationwide, the average monthly payment is <a href="https://www.cbpp.org/families-cannot-afford-modest-rent-with-tanf">less than $500</a>, well below the poverty line and half the average rent for a two-bedroom apartment as of 2021.</p>
<p id="dBCXg7">And seeking out help comes with its disadvantages. Poverty is considered a contributing <a href="https://scholar.harvard.edu/files/kfong/files/fong_cysr_postprint.pdf">risk factor</a> for child neglect, which makes up the <a href="https://www.acf.hhs.gov/media/press/2021/child-abuse-neglect-data-released#:~:text=The%20most%20common%20single%20maltreatment,commissioner%20of%20HHS'%20Children's%20Bureau.">majority</a> of Child Protective Services reports. And as such, CPS continues to <a href="https://www.futurity.org/child-protective-services-welfare-parents-poverty-2488042-2/">scrutinize</a> low-income families for neglect at a <a href="https://imprintnews.org/child-welfare-2/time-for-child-welfare-system-to-stop-confusing-poverty-with-neglect/40222">much higher rate</a> than those who are above the poverty line, even when the <a href="https://www.nyclu.org/en/news/how-so-called-child-welfare-system-hurts-families">resulting investigations</a> can be <a href="https://www.hrw.org/report/2022/11/17/if-i-wasnt-poor-i-wouldnt-be-unfit/family-separation-crisis-us-child-welfare">harmful rather than helpful</a> to vulnerable families. While child poverty rates have fallen, especially since the 2020 <a href="https://www.census.gov/library/stories/2022/09/record-drop-in-child-poverty.html">child tax credit</a> expansion, 12 million children still lived below the poverty line as of 2022, and the system meant to help them is <a href="https://www.penncapital-star.com/commentary/the-u-s-child-welfare-system-is-falling-short-because-of-persistent-child-poverty-opinion/">falling short</a>. When foster kids age out of the system, they face <a href="https://nfyi.org/51-useful-aging-out-of-foster-care-statistics-social-race-media/">higher rates</a> of <a href="https://nfyi.org/issues/homelessness/">homelessness</a> and <a href="https://jlc.org/news/what-foster-care-prison-pipeline">incarceration</a> and an increased likelihood of becoming <a href="https://www.fosterva.org/blog/what-percentage-of-girls-in-foster-care-are-pregnant-by-21#:~:text=A%20Utah%20study%20of%20children,higher%20than%20the%20general%20population.">teen parents</a> when compared with the general population.</p>
<p id="HJAX5K">After the <a href="https://www.vox.com/2022/5/3/23055125/roe-v-wade-abortion-rights-supreme-court-dobbs-v-jackson"><em>Dobbs</em> verdict</a>, 24 <a href="https://www.guttmacher.org/2023/01/six-months-post-roe-24-us-states-have-banned-abortion-or-are-likely-do-so-roundup">states</a> are in the <a href="https://www.cnn.com/2022/06/27/politics/states-abortion-trigger-laws-roe-v-wade-supreme-court/index.html">process</a> of banning or heavily restricting <a href="https://www.vox.com/abortion" data-source="encore">abortion</a> access, and these laws will hit hardest for low-income families and young, single, or Black parents, who are less able to travel to access abortion care. These states, mainly in the South and Midwest, <a href="https://www.commonwealthfund.org/blog/2022/public-health-paradox-states-abortion-laws-maternal-child-health-outcomes">already have</a> disproportionately bad maternal and child health outcomes, with higher rates of maternal death and low birth weight infants. To make matters worse, women denied an abortion end up at even higher <a href="https://www.reuters.com/article/us-health-abortion-hardship/denial-of-abortion-leads-to-economic-hardship-for-low-income-women-idUSKBN1F731Z">risk of poverty</a> — and the <a href="https://reproductiverights.org/maps/abortion-laws-by-state/">abortion bans</a> are mostly in states with <a href="https://www.americanprogress.org/article/weak-safety-net-policies-exacerbate-regional-racial-inequality/">limited</a> and <a href="https://www.propublica.org/article/the-cruel-failure-of-welfare-reform-in-the-southwest">shrinking</a> social safety net programs.</p>
<p id="nJf6U2">Although a year has passed since the <em>Dobbs</em> verdict, data collection is still limited; it takes time for local <a href="https://www.vox.com/health-care" data-source="encore">health care</a> providers to report data at the state or national level, and for reports to be compiled. The Society of Family Planning’s <a href="https://www.societyfp.org/wp-content/uploads/2023/03/WeCountReport_April2023Release.pdf">#WeCount program</a> estimated a decrease of 32,260 in the number of abortions nationwide between July and December 2022. (To put that in perspective, the Guttmacher Institute <a href="https://www.pewresearch.org/short-reads/2023/01/11/what-the-data-says-about-abortion-in-the-u-s-2/">estimated</a> that there were 930,160 abortions nationwide in 2020.) Texas alone — a state with a <a href="https://www.texastribune.org/2023/02/09/texas-foster-care-lawsuit/">notoriously dysfunctional</a> child welfare system — saw an estimated 15,540 fewer abortions over the six-month period. </p>
<p id="z94EOL">It’s not yet clear how many additional births new restrictions will ultimately cause, or what fraction of those children will end up in foster care, but it’s a population at high risk of coming to the attention of Social Services. An <a href="https://www.cwdatasolutions.com/post/forecasting-the-impact-of-abortion-law-changes-on-state-foster-care-systems">October 2022 forecast</a> by data scientist Russ Clay predicts that the <em>Dobbs</em> verdict could mean an 8 to 11 percent increase, or an additional 3,600 to 4,400 children, in the Texas foster care system by 2040, relative to the baseline forecast. </p>
<p id="BzeZXA">“What the <em>Dobbs</em> decision has done is [that] it has continued to show that the government does not care about women who are trying to raise families,” said <a href="https://www.equaljusticeworks.org/fellows/emily-berger/">Emily Berger</a>, director of Los Angeles Dependency Lawyers, the country’s largest legal nonprofit dedicated to representing parents in child welfare court cases. </p>
<p id="WQdwCs">As more infants are likely born to financially struggling parents in the wake of <em>Dobbs</em>, the foster care system will continue to be touted as a potential solution, as it was in the beginning of the <a href="https://www.brookings.edu/blog/up-front/2018/01/31/the-foster-care-system-was-unprepared-for-the-last-drug-epidemic-lets-not-repeat-history/">opioid epidemic</a>. Even before <em>Dobbs</em>, the foster care <a href="https://www.thewellnews.com/child-care/in-the-wake-of-dobbs-uncertainty-grows-for-foster-care-system/">system</a> was <a href="https://www.enewscourier.com/news/how-the-dobbs-decision-affects-women-and-children/article_0d4ef68c-078f-11ed-8c12-3795085e9586.html">already</a> strained and underresourced. It’s easy to fall back on imagining that more funding and more foster parents are the most urgent priority to prepare for surging numbers of neglected children. </p>
<p id="ytJEWH">But nearly everyone that Vox spoke with who works within the system itself thinks that foster care isn’t the answer and that the current child welfare system is one that traps families <a href="https://www.vox.com/poverty" data-source="encore">in poverty</a> and then penalizes them for it. Even when the system functions at its best, separation is still a <a href="https://www.apodcastaboutabortion.com/episodes/why-adoption-isnt-an-alternative-to-abortion">traumatic experience</a> that can affect both the parent and the child for the <a href="https://www.nytimes.com/2021/09/16/opinion/foster-care-children-us.html">rest of their lives</a>. Nine out of 10 women who are <a href="https://www.vox.com/2021/12/8/22822854/abortion-roe-wade-adoption-supreme-court-barrett">denied an abortion</a> want to <a href="https://www.psychologytoday.com/us/blog/the-third-wave/201905/adoption-is-not-solution-abortion">raise their child</a> despite the hardships. Refusing them this opportunity damages communities and propagates a pattern of discrimination that harms the most vulnerable families. </p>
<h3 id="Ea9EZ1">Surveillance agencies, not service providers </h3>
<p id="jroskr">The US child welfare system is <a href="https://www.childwelfare.gov/pubpdfs/cpswork.pdf">complex</a>, with programs run at the state or even local level. The federal <a href="https://www.acf.hhs.gov/cb/about/organization-structure">Children’s Bureau</a> works with these local agencies, following the <a href="https://www.childwelfare.gov/pubPDFs/about.pdf">Child Abuse Prevention and Treatment Act</a> of 1974. CPS isn’t a single organization but refers to <a href="https://en.wikipedia.org/wiki/Child_protective_services#:~:text=Child%20protective%20services%20(CPS)%20is,of%20child%20abuse%20or%20neglect.">many different</a> state departments — though sometimes, as in <a href="https://dcfs.lacounty.gov/">Los Angeles County</a>, child welfare is instead run by the Department of Children and Family Services (DCFS). All of these agencies in theory follow the same federal guidelines, but implementation and specific programs vary massively. </p>
<p id="fCAswd">In the communities that <a href="https://talkpoverty.org/2018/11/16/poverty-neglect-state-took-children/">need support</a> the most, <a href="https://uk.sagepub.com/sites/default/files/upm-assets/40606_book_item_40606.pdf">trust in</a> the child welfare system is low. Families are — quite reasonably — concerned that accepting support services will mean more oversight and monitoring. The ultimate worry for families is that, at some point, a worker in the system will report them to CPS or DCFS for perceived neglect. Because neglect is so <a href="https://www.childwelfare.gov/pubpdfs/define.pdf">broadly defined</a> by both federal and state law, parents fear that resource limitations, like not being able to afford child care or medical care, might be seen as grounds to place their children in foster care. </p>
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<img alt="Kindergarten-aged children wearing colorful backpacks, including a pink backpack featuring several Disney princesses, walk down a linoleum-floored hallway." data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/dPGjaKPySI3XRXWXSV8W5uE0KTs=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24773863/1242680484.jpg">
<cite>Craig Hudson/The Washington Post via Getty Images</cite>
<figcaption>Students line up during a kindergarten orientation at Lyles-Crouch Traditional Academy in Alexandria, Virginia, on August 19, 2022.</figcaption>
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<p id="OLILr1">If a mandated reporter, like a teacher or a <a href="https://www.vox.com/child-care" data-source="encore">day care</a> worker, notices a child coming in hungry or with worn-out clothing, they often have few options other than to call a Child Protective Services hotline. In <a href="https://www.childwelfare.gov/pubpdfs/canstats.pdf">more than half</a> of cases, this leads to a CPS investigation, even if the intent of the call is for <a href="https://sites.utexas.edu/contemporaryfamilies/2020/08/11/cps-brief-report/">additional support</a>. As a result, <a href="https://imprintnews.org/child-welfare-2/nearly-half-of-children-experience-cps-investigations/57396">one in three</a> kids could experience a CPS investigation at some point by age 18, said Kelley Fong, an assistant professor of sociology at the University of California Irvine. These are mostly children in working-class and low-income <strong> </strong>communities, particularly <a href="https://www.risemagazine.org/item/facing-race-in-child-welfare/">communities of color</a>. “Once that process gets in motion, it’s a train that’s on the tracks,” Fong added, “and they start turning over stones.” </p>
<p id="MXnTCs">According to Fong, the <a href="https://sites.utexas.edu/contemporaryfamilies/2020/08/11/cps-brief-report/">vast majority</a> of CPS reports <a href="https://www.theatlantic.com/national/archive/2014/07/in-a-year-child-protective-services-conducted-32-million-investigations/374809/">don’t lead</a> to family separation, but this doesn’t mean that such encounters are harmless. CPS cases can drag on for months, if not years, and <a href="https://www.bryanfagan.com/family-law-blog/2017/july/child-protective-services-investigation-what-to-/">touch on</a> all elements of a family’s life, not just what was initially reported. It can be another way to <a href="https://www.jstor.org/stable/10.7758/rsf.2019.5.1.03#metadata_info_tab_contents">police</a> <a href="https://www.aclu.org/news/womens-rights/family-surveillance-by-algorithm-the-rapidly-spreading-tools-few-have-heard-of">families of color</a>, playing out a pattern of <a href="https://theappeal.org/black-families-matter-how-the-child-welfare-system-punishes-poor-families-of-color-33ad20e2882e/">racial disparities</a> in the US justice system. “They will ask your children how they are disciplined,” Fong said. “They can ask you to complete a <a href="https://www.rosenblumlawlv.com/can-cps-drug-test-me/">drug test</a>. They will walk around your home and kind of assess your private domestic space.” </p>
<p id="UqfaZA">While CPS workers can make referrals for therapy or <a href="https://www.vox.com/parenting" data-source="encore">parenting</a> classes, the services they offer generally don’t address poverty directly — and the offers can easily feel coercive, given that case workers and therapists can and will report on parents to the state. “Child welfare agencies are not service agencies,” said Mishka Terplan, an OB-GYN who works with pregnant patients with addiction in San Francisco. “They’re like surveillance agencies. … They can make services part of an equation, [where] the solution of the equation is either keeping or losing your kid.” When families are afraid of CPS attention, it stands in the way of asking for help.</p>
<p id="HImwFd">The ultimate goal of any child welfare system is to keep children safe. It’s critical to have <em>some </em>kind of support to call in if there are concerns that a child is abused or neglected. But the current system is set up in a way that fails many families, even when individual case workers are trying their best to help. </p>
<h3 id="aOojGT">The realities of separation</h3>
<p id="2YbcPt">Foster care can include “kinship” care by other relatives, often considered the best option, but this isn’t always available or pursued. Across the US, about <a href="https://datacenter.aecf.org/data/line/6243-children-in-foster-care?loc=1&loct=1#1/any/true/2048,574,1729,37,871,870,573,869,36,868/asc/any/12987">400,000 children</a> are in foster care with strangers, under a system that moves them frequently between caregivers, and often <a href="https://www.researchgate.net/publication/264125328_Contact_visits_between_foster_children_and_their_birth_family_The_views_of_foster_children_foster_parents_and_social_workers">fails to prioritize contact</a> with birth parents who many children miss desperately.</p>
<p id="xibnPM">The backdrop for the current foster care system lies with the <a href="https://adoptioninchildtime.org/bondingbook/summary-of-the-adoption-and-safe-families-act-of-1997-pl-105-89">Adoption and Safe Families Act</a>, signed into law by President Bill Clinton in 1997. This law came in response to a reasonable criticism of the child welfare system, <a href="https://sci-hub.wf/10.2307/1228098">repeated</a> over the <a href="https://meridian.allenpress.com/her/article-abstract/43/4/599/30987/Foster-Care-In-Whose-Best-Interest?redirectedFrom=PDF">years</a>: too many children were spending multiple years in foster care without any long-term plan. The proposed solution — to create a clear process and timeline for determining whether a child could return to live with their birth parents or be adopted — was an understandable goal. </p>
<p id="IWMLC7">But while the goal may have been to more quickly reunite families, the actual result <a href="https://imprintnews.org/opinion/we-dont-need-adoption-and-safe-families-act-shorten-foster-care/53970">created</a> rigid and often impossible timelines for families: <a href="https://aspe.hhs.gov/sites/default/files/private/pdf/265036/freeing-children-for-adoption-asfa-pt-1.pdf">18 to 24 months</a> in most cases, or for children under 3, as little as <a href="https://www.onlinemswprograms.com/careers/child-welfare-social-work/">six months</a>. </p>
<p id="Ikdj8f">During this period, parents are still closely and invasively supervised, can be required to attend parenting classes or therapy, and are responsible for traveling to regularly visit their children. For parents who need to take public transit, often over long distances, this can be nearly impossible — and according to experts Vox spoke with, missing a contact visit, even due to bad weather, is seen as a mark against parents’ commitment. </p>
<p id="uzB4t3">Two years may seem like a long time for parents to meet the expectations laid out and prove they can care for their children, but in an overstrained system, where<a href="https://www.childwelfare.gov/pubpdfs/case_work_management.pdf"> social workers</a> often have heavy caseloads, delays add up. Missing and needing to reschedule a court-ordered medical appointment can add months to an already tight timeline. </p>
<p id="0huCm0">In her work representing parents with Los Angeles Dependency Lawyers, Emily Berger believes that, again, this system penalizes low-income parents. “In Los Angeles, for example, [the county] is not paying for court-ordered programs that parents need to do to get their children back,” Berger said. “So if you are a person with a history of mental illness or drug use or abuse, you’re in a position where you need to be paying out of pocket for programs.” </p>
<p id="Y4q6YL">And once children are in foster care, reuniting families can be an uphill battle, one where parents need to perfectly toe the line, submit to ongoing supervision, and meet any requirements that social services asks of them — or risk fully losing their parental rights and having their children placed for adoption. These visits are often supervised by a social worker — in Berger’s area, monitored visits are the default — and parents may be ordered to follow an exact script, even though this can sometimes be upsetting for children. </p>
<p id="FcGDMu">Dominic Benavides, a parent representative with the Washington State Office of Public Defense, says that tension and mistrust can build up between social workers and parents who don’t feel that the system is on their side. “It doesn’t mean that they don’t love and want the best for their children,” Benavides said. “It’s just really hard to constantly come back to a room and negotiate with people who say that you’re untrustworthy or that you’re a bad parent.” </p>
<p id="eOdc8g">Inadequate funding and a shortage of foster homes means that, rather than being placed within a family, children often <a href="https://thehowleronline.org/2072/viewpoint/no-place-like-home-the-us-foster-care-system-is-broken/">end up</a> in group homes, institutions, or even sleeping on the floors of social work offices — which could be considered a more damaging form of neglect than just empty fridges and unwashed clothing. According to Richard Villasana, founder of the nonprofit organization <a href="https://foreverhomesforfosterkids.org/">Forever Homes for Foster Kids</a>, it’s exceptionally hard to find suitable homes for <a href="https://www.davidandmargaret.org/blog.html/article/2021/07/14/disability-among-youth-in-foster-care">children with disabilities or mental health issues</a>. “The ones who are sleeping on office floors are the ones who have the greatest need … either because they were born with a particular issue or because of the trauma they’ve experienced,” he said.</p>
<p id="ZsXlWz">The same resource constraints mean that children who spend over a year in foster care — which is unfortunately <a href="https://www.aecf.org/blog/child-welfare-and-foster-care-statistics">more than 60</a> percent of cases — are often moved <a href="https://www.casey.org/placement-stability-impacts/">repeatedly</a> between foster homes. In addition to the trauma and instability of repeatedly losing their new attachment figures, Villasana believes that these <a href="https://www.theatlantic.com/education/archive/2014/02/every-time-foster-kids-move-they-lose-months-of-academic-progress/284134/">frequent moves</a> are part of why <a href="https://nfyi.org/issues/higher-education/">only about 50</a> percent of former foster youth graduate from high school — <a href="https://nces.ed.gov/programs/coe/indicator/coi/high-school-graduation-rates">compared to 87 percent</a> for the nation as a whole — and only 1 in 25 will complete a four-year college degree. “Some of these kids take the same course two to three times,” Villasana said; with frequent moves, children can end up having to change schools multiple times mid-school year. “If you don’t complete it … they can’t count it.”</p>
<p id="6z3Lmo">In unlucky cases, foster homes can be <a href="https://www.usatoday.com/in-depth/news/investigations/2021/03/18/foster-care-children-starved-beaten-molested-florida-reports-show/6782615002/">actively abusive</a>. And because the system is overburdened, the processes for supervising foster parents aren’t always carried out, and cases of abuse or neglect by foster carers are very likely <a href="https://www.biometrica.com/gaps-in-an-overburdened-system-mean-that-children-in-foster-care-are-too-susceptible-to-abuse/">underreported</a>. Callahan saw this with many of her foster children. “Kids were removed from chaos but put into hell,” she said.</p>
<p id="roS6FV">Fortunately, this degree of abuse is a worst-case scenario. In Callahan’s experience, despite stereotypes that describe foster carers as “either saints or just horrible people in it for the money,” most foster parents she knew were dedicated “but had no idea how hard it was going to be.” But even if a foster home offers safety and three meals a day, it may not provide the same emotional security as a biological family member. </p>
<h3 id="cu9kn4">Moving forward </h3>
<p id="Vq4oph">Obviously, in an ideal world, no child would ever be homeless, go hungry, or be left alone while a parent worked due to lack of child care. Unfortunately, the <em>Dobbs</em> verdict likely means that thousands more children will be born into homes where this is a real risk. Rather than providing support to keep families together, the current child welfare system is quick to take children into a foster care system that lacks the resources to consistently keep them safe<em>, </em>let alone provide them with a consistent, supportive, and loving home.</p>
<p id="go1AhL">Not all families can be reunified. While child abuse makes up a minority of CPS cases, even parents who are motivated to reunite with their child and are trying to do their best may have challenges, like drug addiction, that are incompatible with healthy parenting. But given how badly the overburdened system is already failing many children in foster care, this only makes it more important to keep families together in any cases where there is no evidence of abuse, and where material support is enough to let a parent meet their child’s needs. </p>
<p id="VpWo2z">Case workers can end up feeling that once a child is in a foster home — often, as Benevides points out, “situations with quite wealthy parents, who are very privileged in their access to resources” — returning them to live with a low-income single parent means depriving them of opportunities. This perception can hold even if there are no other parenting concerns, and the need is for material support. As Berger put it, workers can “impose their own ideas about what families should look like. … And sometimes they forget that there is an absolutely priceless benefit a child gets from being raised with their families and communities of origin.”</p>
<p id="D5hSc2">Preventing this at the source would mean giving the people who so often flag concern about children, like teachers, day care workers, or family doctors, more options for supporting families in need without triggering a process that results in an invasive — and expensive — investigation. There are <a href="https://nccpr.org/the-evidence-is-in-foster-care-vs-keeping-families-together-the-definitive-studies/">already studies</a> indicating that <a href="https://drive.google.com/file/d/0B291mw_hLAJsV1NUVGRVUmdyb28/view?resourcekey=0-tBFng8I-FIQ13H7kkC871A">keeping families together</a> likely has better outcomes for children; ideally, this would be built into child <a href="https://www.vox.com/social-programs" data-source="encore">welfare programs</a>, with support workers able to <a href="https://drive.google.com/file/d/0B291mw_hLAJsbnZTbE5xNjZsd1U/view?resourcekey=0-SSFy4Q1WRxSsqunD27-bbg">work closely</a> and build trust with parents.</p>
<p id="H5EWCq">“There’s too much concern about how they are going to get on the bus and get them to a doctor,” Benavides said. “Or they don’t have a car — are you sure that they’re going to get to school on time? But they present those issues, and far too often don’t present a remedy.”</p>
<p id="XAXTSe">The remedy starts with a focus on prevention; if a teacher or day care worker is concerned about a child’s well-being at home, they should have options other than a CPS investigation and potential removal to foster care. Given the mistrust toward child welfare services in many disadvantaged populations, <a href="https://www.childwelfare.gov/topics/famcentered/communities/">community-based initiatives</a> that aren’t directly run through CPS might be better. There are <a href="https://www.casey.org/media/community-based-family-support.pdf">dozens</a> such programs, including Oregon’s <a href="https://ccswv.org/wp-content/uploads/2022/07/FHIbrochure_sm.pdf">Fostering Hope Initiative</a>, which has a leadership council open to anyone in the community and provides financial support, help finding affordable housing, and tangible goods like food boxes or diapers to families.</p>
<p id="qWxKsD">If foster care is necessary to keep a child safe, a child’s attachments will be less disrupted if they can still see their parent or parents, an opportunity that Michael was never given until Callahan went above and beyond for him. Under the <a href="https://creatingafamily.org/foster-care/co-parenting-in-foster-care-establish-relationship-with-birth-parents/">co-parenting</a> approach, birth parents work together with the foster parents and share parenting responsibilities. This can go as far as <a href="https://www.childwelfare.gov/topics/supporting/support-services/familycare/#shared%20family">Shared Family Care</a>, or whole family foster care, where the parent and child live in the same home with the foster parents, who can support and mentor them and help them develop parenting skills. It’s also important to investigate options for <a href="https://www.childwelfare.gov/pubpdfs/placement.pdf">kinship care</a>, including with “fictive kin” — the term for a close family friend not related by blood but with whom a child already has a relationship — and to make sure that the relative has the support they need. </p>
<p id="lBY9L2">There’s also the element of cost. Nearly everyone I spoke to, from social workers to family law representatives, believes that higher cash benefits for families — enough to actually cover living expenses — would make a huge difference. In fact, the Covid stimulus tax credits brought child poverty to a <a href="https://www.vox.com/2022/9/14/23352022/child-poverty-covid-tax-credit">record low</a>, but this progress was <a href="https://www.npr.org/2022/09/14/1122895313/child-poverty-is-at-a-historic-low-according-to-the-census-bureau">quickly reversed</a> when the program ended. </p>
<p id="fgPxpK"><a href="https://wehavekids.com/adoption-fostering/What-does-being-a-foster-parent-really-pay">Monthly payments</a> to foster parents are usually significantly more than the cash welfare benefits available to low-income parents. Given the other costs for child welfare agencies, like staffing time, the <a href="https://talkpoverty.org/2019/08/23/government-more-foster-adoption-reuniting/">actual cost</a> to the state is much higher. Child welfare funding is a complicated mix of federal, state, and local, with significant state discretion on how to spend it. But in <a href="https://cms.childtrends.org/wp-content/uploads/2021/03/ChildWelfareFinancingReport_ChildTrends_March2021.pdf">2018</a>, it came to a total of $33 billion; on average, $450 was given per child per year, or $2,800 for each of the approximately <a href="https://firstfocus.org/wp-content/uploads/2019/10/FF_2018-Snapshot-of-Children-in-Poverty.pdf">12 million</a> children living below the poverty line. Forty-five percent of funds <a href="https://cms.childtrends.org/wp-content/uploads/2021/03/ChildWelfareFinancingReport_ChildTrends_March2021.pdf">go toward foster placements</a>; only 15 percent are spent on preventive services. </p>
<p id="cRT3Gj">But from the perspective of children in the foster care system — not to mention their parents — the best scenario is one where they were never separated at all. </p>
<p id="MWS63x">Since leaving the foster care system a decade ago, Michael has tried to move on with his life. “ I haven’t paid too much attention to what currently needs to change,” he says. But the effects of his family’s separation are still permanent, and he thinks all of it could have been avoided with a few simple interventions. “She was given a deadline to meet, and when she didn’t meet that deadline, my siblings and myself were lost to the system. Had DHS offered tools to help her, such as a babysitter, I think my mom could have managed and been able to raise us.” </p>
<p id="vEZ5k4">Michael’s birth mother is now a foster carer herself. </p>
<p id="rgsad6"><em>Miranda Dixon-Luinenburg is a freelance writer and former Future Perfect fellow based in the Bay Area.</em></p>
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https://www.vox.com/future-perfect/2023/7/9/23786276/foster-care-adoption-system-poverty-neglect-dobbs-abortionMiranda Dixon-Luinenburg2022-10-20T05:55:00-04:002022-10-20T05:55:00-04:00Julia Galef thinks we should be more like scouts instead of soldiers
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<img alt="An illustration of Julia Galef." src="https://cdn.vox-cdn.com/thumbor/CdUzeZbBoWkL9UT1f7_tkAQQpyU=/199x0:1639x1080/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71506645/JuliaGalef.0.jpg" />
<figcaption>Rebecca Clarke for Vox</figcaption>
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<p>Rationalist Julia Galef believes everyday people will benefit from assessing all sides of a debate, rather than just their own.</p> <p id="wnnAls"></p>
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<p id="F0yMmR">I first<strong> </strong>met Julia Galef in 2012 at the inaugural weekend workshop of the <a href="https://www.rationality.org/">Center for Applied Rationality</a> (CFAR), a nonprofit that Galef co-founded that same year to teach the concepts and practical skills of human rationality. </p>
<p id="F50pNl">For CFAR, this means refining techniques for reasoning more accurately, understanding the world, and making plans that work (and happen on schedule!). At the retreat, Galef advised a room full of philosophy students and programmers (and me, a random intensive care unit nurse) on how to think about probabilities and uncertainty in real-life contexts. </p>
<p id="vOqWSx">A decade later, Galef continues to write about and advocate for a concept that is more important than ever in our irrational age: that we shouldn’t assume which conclusions must be defended, and need to stay open to uncertainty. </p>
<p id="Qb8ycd">She and the other founders of CFAR — who met via the rationality blog <a href="https://www.lesswrong.com/tag/effective-altruism">LessWrong</a> (for which I’ve written) — believe that human intelligence alone <a href="https://www.lesswrong.com/posts/f4CZNEHirweN3XEjs/teachable-rationality-skills">isn’t enough</a> to address the biggest problems facing the world. While intelligence is responsible for the astounding advances in technology, prosperity, and quality of human lives over the past several thousand years, it can also be applied to causing massive harm. </p>
<p id="3T1t2b">As the Nobel Prize-winning economist and psychologist <a href="https://scholar.princeton.edu/kahneman/home">Daniel Kahneman</a> argued in his influential 2011 book <a href="https://go.skimresources.com?id=66960X1516588&xs=1&url=https%3A%2F%2Fbookshop.org%2Fp%2Fbooks%2Fthinking-fast-and-slow-daniel-kahneman%2F943943%3Fean%3D9780374533557&xcust=VoxFuturePerfect50101922"><em>Thinking, Fast and Slow</em></a>, human beings are prone to systematic errors: making assumptions or jumping to conclusions, seeing what we expect to see, and often leaning over-optimistic on plans and deadlines. </p>
<p id="BjcNu3">LessWrong was a space to discuss ways of <a href="https://www.lesswrong.com/posts/f4CZNEHirweN3XEjs/teachable-rationality-skills">mitigating and working around</a> these very human flaws, but discussions there tended to be abstract. CFAR, by contrast, hoped to provide concrete, immediately useful training. In the 2012 workshop I attended, we learned to apply <a href="https://www.vox.com/future-perfect/2018/11/30/18096751/bayes-theorem-rule-rationality-reason">Bayes’ theorem</a> — the formalized math for <a href="https://arbital.com/p/bayes_rule/">changing your mind</a> based on new information about an uncertain situation — to our thinking and carefully mapped out the different, sometimes conflicting motivations and goals involved in major life decisions.</p>
<p id="PQo2H8">Galef came to the project with a <a href="https://juliagalef.com/about-me/">varied background</a>: After completing an undergraduate degree in statistics, she did social sciences research at Harvard and MIT, international economics work for Harvard Business School, and spent several years in New York as a <a href="https://juliagalef.com/older-writing/">freelance journalist</a>. Shortly before CFAR came together, she co-launched the podcast <a href="http://rationallyspeakingpodcast.org/about-the-podcast/"><em>Rationally Speaking</em></a>, where she interviews a wide range of experts on topics related to rationality and effective altruism. </p>
<p id="zI35EQ">Galef <a href="https://nymag.com/intelligencer/2021/04/julia-galef-scout-mindset.html#:~:text=In%202016%2C%20Galef%20left%20CFAR,by%20Penguin%20on%20April%2013.">moved on from CFAR in 2016</a> and pivoted to working on a book about rationality, <a href="https://bookshop.org/p/books/the-scout-mindset-why-some-people-see-things-clearly-and-others-don-t-julia-galef/12475006?ean=9780735217553"><em>The Scout Mindset: Why Some People See Things Clearly and Others Don’t</em></a>. Published last year, the book delves into the importance of curiosity and genuinely trying to learn the details of a situation rather than fighting for a particular side. In Galef’s view, this means acting more like a scout on the battlefield of debate, rather than a single-minded soldier.</p>
<p id="rMBxik">Galef doesn’t claim to have solved the challenges of acting rationally even for herself. But as she said in a <a href="https://www.vox.com/future-perfect/22410374/julia-galef-book-scout-mindset-interview-think">Vox interview</a> after the book’s release: “Even when you’re motivated to try to improve your own reasoning and decision-making, just having the knowledge itself isn’t all that effective. The bottleneck is more like wanting to notice the things that you’re wrong about, wanting to see the ways in which your decisions have been imperfect in the past, and wanting to change it.” </p>
https://www.vox.com/future-perfect/23391917/future-perfect-50-julia-galef-cfar-rationalistMiranda Dixon-Luinenburg2022-10-20T05:55:00-04:002022-10-20T05:55:00-04:00Jennifer Doleac is helping us find nuanced, effective ways to fight crime
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<img alt="An illustration of the head and shoulders of Jennifer Doleac." src="https://cdn.vox-cdn.com/thumbor/HK6v8R0wDktVr_mLg2XH-YDwBA4=/287x0:1727x1080/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71507465/JenniferDoleac.0.jpg" />
<figcaption>Rebecca Clarke for Vox</figcaption>
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<p>The economist has conducted and popularized research that can help break our policy deadlocks on guns and crime.</p> <p id="Iuj1Pj"></p>
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<p id="ohC1vw">In the midst of frantic calls for action after school shootings, like the one earlier this year in Uvalde, Texas, Jennifer Doleac’s <a href="https://www.vox.com/future-perfect/23150764/gun-violence-prevention-gun-control-jennifer-doleac">measured response</a> stands out: Policymakers don’t <em>really</em> know what would help, because — while every school shooting is a tragedy — these events are rare and thus <a href="https://twitter.com/jenniferdoleac/status/1534491312153567232">hard to study</a>. </p>
<p id="q3OZdX">Hasty reactions to a single, widely publicized event are rarely the best long-term solution. Sometimes, it can even make things worse. After the Sandy Hook school shooting, as Doleac points out in her 2018 article for <a href="https://www.theregreview.org/2018/11/09/gun-regulation-costly-not-only-option/">The Regulatory Review</a>, people<strong> </strong>worried about violent crime purchased <a href="http://jhr.uwpress.org/content/early/2018/04/02/jhr.54.4.1016.8287R2.abstract">more guns</a>, which, inevitably, led to a matching spike in gun <a href="https://web.archive.org/web/20180403144516/http://www.efm.bris.ac.uk/economics/working_papers/pdffiles/dp18694.pdf">homicides</a> and <a href="https://www.science.org/doi/10.1126/science.aan8179">accidental</a> deaths. </p>
<p id="O5AYP1">As an associate professor of economics at Texas A&M University, Doleac looks at criminal justice policy through the lens of causal factors on a society-wide level. She founded <a href="https://www.charitynavigator.org/ein/863095957">Doleac Initiatives</a>, a policy research nonprofit, and runs a <a href="https://podcasts.apple.com/us/podcast/probable-causation/id1458276452">podcast</a> about law, crime, and economics. Across her work, she uses careful, data-based analyses to unpack systemic factors like poverty that influence gun deaths, particularly gun homicides, and what social programs actually address them. She also digs through the crime literature, synthesizing and signal-boosting other researchers’ work that she believes calls for further study or investment via her <a href="https://twitter.com/jenniferdoleac?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor">Twitter</a>, interviews, and articles.</p>
<p id="iHgzlZ">Some of her most valuable work is in helping people think through what the data appears to show.<strong> </strong>Because gun laws in a region are already heavily tied to <a href="https://davidepstein.bulletin.com/why-comparing-gun-ownership-rates-across-states-shouldn-t-inform-policy/?section=comments">existing public opinion</a>, Doleac warns that the data on gun restrictions that find reductions in gun ownership or gun-related deaths shouldn’t be taken at face value, since people in regions that pass gun control laws are more likely to have generally anti-gun sentiments. </p>
<p id="kMuKZk">Since most research on the ramifications of gun laws doesn’t allow for natural experiments, Doleac focuses on the interventions that do — for example, the varying times of the <a href="https://www.brookings.edu/research/the-geography-incidence-and-underreporting-of-gun-violence-new-evidence-using-shotspotter-data/">youth curfew</a> in Washington, DC. </p>
<p id="9uCJ2R">There are other effective ways to reduce gun deaths that aren’t mired by politics or by confounding factors, Doleac points out.<strong> </strong>For example, when I interviewed her in May, she highlighted the <a href="https://academic.oup.com/qje/article-abstract/132/1/1/2724542?redirectedFrom=fulltext&login=false">work done</a> by researcher Sara Heller and her colleagues showing that cognitive behavioral therapy programs for vulnerable youth lowered violent crime arrest by up to 50 percent — a vastly stronger effect than the mandatory waiting periods. </p>
<p id="CnvcVE">These programs may be hard to implement widely, but Doleac believes that summer job programs, like the <a href="https://academic.oup.com/qje/article-abstract/131/1/423/2461127?redirectedFrom=fulltext&login=false">youth job lottery</a> in New York City, are much easier to scale and can reduce mortality for the youth included by 18 to 20 percent, as<strong> </strong>Judd Kessler and colleagues at J-PAL <a href="https://www.povertyactionlab.org/evaluation/effects-youth-employment-evidence-new-york-city-summer-youth-employment-program">found</a>. “When policymakers and practitioners ask me what they can do, what’s a reliable way to reduce crime in general and violent crime in particular, summer jobs are always the first thing I bring up,” Doleac said.</p>
<p id="rKAgAh">Doleac has looked into a long list of similar interventions, including the effects of <a href="https://www.nber.org/papers/w21787">air pollution</a> on gun crime, which she hopes will be less politicized and more feasible to implement. Setting policy in an area with so many competing and confounding factors, and often limited data on outcomes, is always going to be a challenge and an ongoing process, but — and this is what makes her essential — Doleac takes the long view. </p>
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https://www.vox.com/future-perfect/23366558/future-perfect-50-jennifer-doleac-economistMiranda Dixon-Luinenburg2022-10-20T05:55:00-04:002022-10-20T05:55:00-04:00Our health care data infrastructure is broken. Caitlin Rivers hopes to fix it.
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<img alt="An illustrated portrait of Caitlin Rivers." src="https://cdn.vox-cdn.com/thumbor/st0rP7-yeouodV2_VFhOTqb8vg0=/160x0:1600x1080/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71496850/CaitlinRivers.0.jpg" />
<figcaption>Rebecca Clarke for Vox</figcaption>
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<p>Without accurate data on disease and outcomes, policymakers can’t make good public health decisions.</p> <p id="tvFgPL"></p>
<p id="YJC646">Without accurate data, it’s tough for policymakers to make good public health decisions. During the beginning of the Covid pandemic, the US was <a href="https://preventepidemics.org/covid19/press/most-of-united-states-not-reporting-essential-covid-19-data/">called out</a> as one of the worst performers in response, partly because, beyond the <a href="https://www.nytimes.com/interactive/2022/02/01/science/covid-deaths-united-states.html">sheer number</a> of deaths, critical state-level data on positive tests, case counts, and contact tracing <a href="https://www.nejm.org/doi/full/10.1056/nejmp2014836">still weren’t being</a> reported across most of the country. </p>
<p id="o6DHZu">Because of how <a href="https://www.vox.com/future-perfect/2022/8/14/23302054/monkeypox-data-health-care-covid-collection">fragmented</a> the American health care system is, not every hospital or government agency tracks information the same way. This can lead to vital information getting lost or delayed when gathered by state or federal public health departments. </p>
<p id="V7Etxm">More information and better data infrastructure is exactly what Caitlin Rivers, an <a href="https://publichealth.jhu.edu/faculty/3525/caitlin-m-rivers">epidemiologist</a> with the Johns Hopkins Center for Health Security, has worked tirelessly to bring attention to — in the hopes that government officials can improve outcomes for any disease or outbreak.</p>
<p id="SjNRY2">“The topic is not a magnet for clicks,” said Rivers about metrics and data in a Substack post on the <a href="https://caitlinrivers.substack.com/p/sustaining-commitment-through-panic">monkeypox</a> outbreak response. “But I think it remains a big missing piece of our response.” </p>
<p id="M7oQdZ">In the first half of 2020, she testified in <a href="https://www.centerforhealthsecurity.org/news/center-news/2020/2020-05-06-testifimonyUSHouseRepCommittee.html">front of Congress</a>, pushing hard to increase testing capacity and contact tracing so that states in lockdown could make an informed decision on when and how quickly to reopen. On <a href="https://twitter.com/cmyeaton/status/1288552131692290049">Twitter</a> and in <a href="https://www.scientificamerican.com/article/what-coronavirus-emergency-measures-could-u-s-communities-take/">interviews</a>, she was outspoken about her recommendations, repeatedly emphasizing the need for information<em> </em>to come before decision-making. </p>
<p id="MmrQHq">“In the US, situational awareness is largely courtesy of volunteer projects and 50 state health dept websites,” she <a href="https://twitter.com/cmyeaton/status/1245165261554176001">tweeted</a> in March 2020, emphasizing the need to “modernize our surveillance and reporting infrastructure to be able to respond effectively.” </p>
<p id="15Bap6">Rivers had already accumulated years of expertise in pandemic forecasting when COVID hit. She conducted her PhD studies at the same time as the <a href="https://www.vox.com/2015/1/23/18089020/ebola-facts-you-need-to-know">Ebola outbreak</a> in West Africa in 2014-16, during which she helped prepare <a href="https://www.centerforhealthsecurity.org/our-work/publications/review-of-international-efforts-to-strengthen-the-global-outbreak-response-system-since-the-201416-west-africa-ebola-epidemic">reports</a> for the White House. In 2019, working with the Center for Health Security at John Hopkins, she co-authored a report highlighting the need for “<a href="https://www.nature.com/articles/s41467-019-11067-2">outbreak science</a>” to model the course of a pandemic and aim the response. </p>
<p id="nmSYaW">The US response to Covid showed that much work still needed to be done. “Things did not unfold as I would have liked them to,” Rivers told <a href="https://www.science.org/content/article/fight-covid-19-young-epidemiologist-bridges-gulf-between-science-and-us-politics">Science</a> in 2020. The infrastructure to rapidly scale up testing and contact tracing — or even for individual states to <a href="https://yourlocalepidemiologist.substack.com/p/why-is-us-national-data-so-terrible">report their numbers</a> consistently to the federal public health agencies — just didn’t exist. As part of the effort to improve pandemic response, the Centers for Disease Control and Prevention in 2021 established a “<a href="https://www.nytimes.com/2021/11/22/magazine/cdc-pandemic-prediction.html">weather service</a>” pandemic <a href="https://www.washingtonpost.com/health/2022/04/19/new-cdc-team-early-alert-pandemic/">forecasting</a> project, with Rivers — who had <a href="https://www.foreignaffairs.com/articles/united-states/2020-06-29/how-forecast-outbreaks-and-pandemics">advocated</a> for such efforts in the past — tapped to be associate director of the effort. </p>
<p id="TM2nev">Beyond raising awareness for better data infrastructure, Rivers highlights places where public health experts themselves can improve. Her <a href="https://substack.com/profile/99891602-caitlin-rivers">Substack</a> regularly discusses the lessons learned from Covid and how to apply them to the recent monkeypox outbreak, future pandemics, or the return of older threats, like polio. Rivers stresses that preparations need to be in place <em>before </em>a pandemic and be maintained after the pandemic ends.</p>
<p id="X8bcSw">“A cycle of panic and neglect shadows public health: frenzied action tends to be followed by loss of interest as a threat recedes,” she wrote for <a href="https://www.nature.com/articles/d41586-022-02763-z">Nature</a>. “Public-health officials, governments and advocates must not let that impulse prevail.” </p>
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https://www.vox.com/future-perfect/23391784/future-perfect-50-caitlin-rivers-epidemiologistMiranda Dixon-Luinenburg2022-10-20T05:55:00-04:002022-10-20T05:55:00-04:00Jason Matheny is helping humanity prepare for the existential threats of the future
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<img alt="An illustration of Jason Matheny." src="https://cdn.vox-cdn.com/thumbor/k2HsWepEmfQgSOnUh7Givg-j1kk=/240x0:1680x1080/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71496711/JasonMatheny.0.jpg" />
<figcaption>Rebecca Clarke for Vox</figcaption>
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<p>From AI to bioengineered risks, Jason Matheny studies what governments will face in the coming years.</p> <p id="wnnAls"></p>
<p id="0WVFox">Jason Matheny has been <a href="https://www.rand.org/blog/rand-review/2022/08/the-future-could-be-brilliant-rands-ceo-is-an-apocaloptimist.html">described</a> as an “apocaloptimist” — which, according to Matheny, means he sees “that we’re on a really good trajectory, if we can just avoid any threats to our existence.” The blend of hope for a better future alongside an intense focus on potential threats and barriers to that future is a hallmark of his work for the last decade. </p>
<p id="ZlKuWy">Matheny started out with the <a href="https://www.fhi.ox.ac.uk/about-fhi/">Future of Humanity Institute</a> (FHI), a research center at Oxford University that studies existential threats to humanity, whether from artificial intelligence, bio-engineered pandemics, or more bizarre dangers. Studying the future, naturally, has made Matheny’s work ahead of the curve, and it has some serious staying power.<strong> </strong>Matheny’s 2007 paper on <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1539-6924.2007.00960.x">reducing the risk</a> of human extinction, where he argues that investing in nearer-term problems like world hunger could indirectly reduce the risk of catastrophic global threats, is still being <a href="https://www.semanticscholar.org/paper/Reducing-the-Risk-of-Human-Extinction-Matheny/991af6e8dfd4e375625db8d513164265747dda1f?sort=pub-date">cited to this day</a>.</p>
<p id="mSYue9">Because of his unique understanding of existential risk, Matheny joined the US intelligence community to modernize its perspective on what risk could be. In 2009, Matheny left FHI for<strong> </strong>the Intelligence Advanced Research Projects Activity (<a href="https://www.iarpa.gov/">IARPA</a>), the US intelligence community’s version of <a href="https://www.darpa.mil/">DARPA</a>. IARPA invests in a wide <a href="https://www.iarpa.gov/research-programs">range of cutting-edge speculative research projects</a> in areas like AI and synthetic biology, including a <a href="https://en.wikipedia.org/wiki/Aggregative_Contingent_Estimation_(ACE)_Program">tournament</a> on geopolitical forecasting for national intelligence, which Matheny helped run from 2010 to 2015. </p>
<p id="doficV">In 2018, he <a href="https://www.nscai.gov/commissioners/jason-matheny/">moved to</a> the National Security Commission on Artificial Intelligence, a US <a href="https://www.nscai.gov/">government agency</a> that advises Congress on how AI impacts national security. Around the same time, he founded, with Georgetown University, the <a href="https://cset.georgetown.edu/">Center for Security and Emerging Technology</a> (CSET), an organization also aimed at providing data-based recommendations to US policymakers on changes related to progress in artificial intelligence. </p>
<p id="sm89Nc">“There are a range of challenges related to AI, but national security is a critical area of focus,” Matheny <a href="https://www.georgetown.edu/news/qa-with-jason-matheny-founding-director-of-the-center-for-security-and-emerging-technology/">said</a> of his work at CSET, citing “cybersecurity, intelligence, and systems for analysis and collection, as well as AI that is embedded in weapon systems of competing nations” as particularly key issues. </p>
<p id="J4QJRq">In July, Matheny became CEO of the Rand Corporation, the venerable California-based policy <a href="https://www.rand.org/">think tank</a> that funds research on technology, infrastructure, health care, energy, climate, and many other areas. He’s especially focused on preventing “<a href="https://www.rand.org/research/projects/truth-decay.html">truth decay</a>” — the decreasing trust in facts and data within the American political debate — and how, across the board, this decay could hold back efforts to improve policy. He still prioritizes <a href="https://www.rand.org/blog/rand-review/2022/08/the-future-could-be-brilliant-rands-ceo-is-an-apocaloptimist.html">preventing technological catastrophe</a> while remaining hopeful that technology can, if used cautiously, solve rather than cause more problems. </p>
<p id="cioxZx">“We now have a moment where we need to think about what will define the next 75 years,” Matheny <a href="https://www.rand.org/blog/rand-review/2022/08/the-future-could-be-brilliant-rands-ceo-is-an-apocaloptimist.html">says</a>. “If you could read a history book in the year 2098, what are going to be the key themes, the highlights?” He adds that he hopes the histories will include Rand “reducing the risk of human extinction by .00000001 percent or greater. Hopefully greater.”</p>
https://www.vox.com/future-perfect/23393262/future-perfect-50-jason-matheny-rand-corporationMiranda Dixon-Luinenburg2022-10-20T05:55:00-04:002022-10-20T05:55:00-04:00Scientific progress is at risk of slowing down. Saloni Dattani is making sure it doesn’t.
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<img alt="A portrait illustration of Saloni Dattani." src="https://cdn.vox-cdn.com/thumbor/nFDZw6Uh7KkfM5JN6Twbx444l88=/182x0:1622x1080/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71507718/SaloniDattani.0.jpg" />
<figcaption>Rebecca Clarke for Vox</figcaption>
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<p>Transparency, accessibility, and understandable analyses are all ways this researcher delivers science to the masses.</p> <p id="wnnAls"></p>
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<p id="E6N71F">From discovering the secrets of the atom to forging new gene editing technology, science has brought us closer to understanding the world around us — and each other. But despite the achievements of the past century, in recent decades that progress has <a href="https://marginalrevolution.com/marginalrevolution/2019/11/is-the-rate-of-scientific-progress-slowing-down.html">slowed down</a>, partially because of challenges like <a href="https://www.vox.com/future-perfect/2022/9/18/23356630/open-science-academic-research-paywall-biden">paywalled journals</a> and slow-turnaround peer review. Without more rapid scientific progress, we risk being mired in stagnation.</p>
<p id="ZGyigm">“Science needs to step up,” <a href="https://www.worksinprogress.co/issue/the-speed-of-science/">writes</a> researcher Saloni Dattani, who specializes in making science accessible and providing smart, digestible analyses on the world’s most important questions. </p>
<p id="58iBKy">Seeking out hard data and putting assumptions to the test is how Dattani thinks, and much of her writing is focused on advocating for better data transparency. She’s a part-time researcher for <a href="https://ourworldindata.org/about">Our World in Data</a> — a UK-based nonprofit that publishes free, easy-to-understand statistics that give us a clearer picture of how things actually are, versus what we assume them to be. </p>
<p id="Dby2HK">At Our World in Data, she collects and fact-checks data on health-related topics, including <a href="https://ourworldindata.org/coronavirus">Covid-19</a> and <a href="https://ourworldindata.org/what-is-depression">mental health</a>. Our World in Data’s Covid dashboard, which she contributed to, was a <a href="https://www.nature.com/articles/s41597-022-01616-8">key source</a> of information for evaluating the effectiveness of lockdowns and other public health measures.</p>
<p id="cTeP4L">Dattani also has an impressive number of side projects for someone who is also working on a PhD in <a href="https://www.kcl.ac.uk/people/saloni-dattani">psychiatric genetics</a>. In 2020 — as the world was awash in bad Covid forecasts — she praised the “<a href="https://unherd.com/thepost/in-praise-of-the-covid-superforecasters/">superforecasters</a>” who made testable predictions about the pandemic, and were often right. (Dattani herself <a href="https://twitter.com/salonium/status/1330787702787043328?s=20">correctly predicted</a> that a vaccine would be available by the end of 2020, at a time when many <a href="https://www.newscientist.com/article/mg24632804-000-why-itll-still-be-a-long-time-before-we-get-a-coronavirus-vaccine/">experts</a> were <a href="https://www.independent.co.uk/news/uk/politics/coronavirus-uk-vaccine-lockdown-face-masks-boris-johnson-a9508511.html">skeptical</a>.) </p>
<p id="52nvVY">That same year, Dattani also helped found <a href="https://www.worksinprogress.co/about/">Works in Progress</a>, an online magazine that <a href="https://twitter.com/worksinprogmag">shares original ideas</a> relevant to making progress on the world’s biggest challenges. As well as new science, Works in Progress covers economics, culture, and politics, hosting writers who can provide detailed and thoughtful deep dives into complex issues.</p>
<p id="m3CkYF">Her interests are widespread, but the throughline is clear, data-based reasoning. In 2019, she spoke on the podcast <a href="https://podcasts.apple.com/ca/podcast/rationally-speaking-239-saloni-dattani-on-debate-over/id351953012?i=1000448422026&l=fr"><em>Rationally Speaking</em> about</a> the debate over gender differences in brains, and her recently launched <a href="https://salonium.substack.com/">Substack</a> newsletter ranges from the evolution of <a href="https://salonium.substack.com/p/7-how-we-adapted-to-milk-and-how">lactose tolerance</a> to potential vaccines <a href="https://salonium.substack.com/p/6-vaccines-against-cancers">against cancer</a>. Dattani cares about highlighting new scientific research that may be relevant to readers’ lives, and demonstrating how to interpret its results. Instead of keeping her analysis and research behind a paywall (her Substack is free)<strong> </strong>or only talking to other academics, Dattani tries to reach people where they are: Twitter, podcasts, newsletters, publications, wherever. </p>
<p id="zN10qV">Dattani’s skill at interpreting and explaining data was recognized this July, when she was recommended for a statistical commentary award from the <a href="https://www.kcl.ac.uk/news/saloni-dattani-highly-commended-for-royal-statistical-society-award">Royal Statistical Society</a> for her <a href="https://www.newstatesman.com/health-science/2021/12/the-crisis-in-covid-vaccine-messaging-is-leaving-pregnant-women-unprotected-from-omicron">New Statesman article</a> about Covid-19 vaccine messaging for pregnant women. She continues to provide clear and informative coverage on the latest health news, like <a href="https://ourworldindata.org/monkeypox">monkeypox</a>, and advocates for <a href="https://salonium.substack.com/p/5-being-ambitious-with-science-reform">reform in science</a>. </p>
<p id="WlOtjP">“My motivation for writing [the New Statesman] article was the same as the motivation I have for all my science writing today,” Dattani <a href="https://salonium.substack.com/p/4-uncovering-the-human-genome">writes</a>. “Here was an issue where the evidence was so abundantly clear, but the messaging had failed the public.”</p>
<p id="IFcj1W">Not every researcher is ahead of the curve all of the time, but Dattani’s approach to her work lends itself to making sure that prescient progress can move forward instead of being held back.</p>
https://www.vox.com/future-perfect/23393557/future-perfect-50-saloni-dattani-researcherMiranda Dixon-Luinenburg2022-09-18T07:00:00-04:002022-09-18T07:00:00-04:00Tearing down the academic research paywall could come with a price
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<img alt="A searcher works in an oncology laboratory at the research and development site of French pharmaceutical company." src="https://cdn.vox-cdn.com/thumbor/G0a9H9R0Wl0CYN9oqrNBXz194XY=/334x0:5667x4000/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71382764/1243161600.0.jpg" />
<figcaption>Thomas Samson/AFP via Getty Images</figcaption>
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<p>Why hide taxpayer-funded research behind paywalls? It’s complicated.</p> <p id="09sFZt">Right now, the majority of published scientific findings — and the vast majority of prestigious new research — is hidden behind paywalls. Most of the <a href="https://www.ilovephd.com/top-100-journals-in-the-world-with-impact-factor/">top scientific publications</a> charge readers high fees for access, with prices that are <a href="https://library.missouri.edu/news/lottes-health-sciences-library/scholarly-publishing-and-the-health-sciences-library">rising faster than inflation</a>. An annual membership with <a href="https://www.nature.com/nature/subscribe"><em>Nature</em></a> costs $199, <em>Science</em> <a href="https://promo.aaas.org/science/join/?CTC=SMHPJN">starts at $79 per year</a>, and <a href="https://www.thelancet.com/journals/lancet/subscribe"><em>The Lancet</em></a> charges $227. And these are only a few of the <a href="https://www.ilovephd.com/top-100-journals-in-the-world-with-impact-factor/">hundreds of journals</a> where new research appears. </p>
<p id="uITDeS">This money goes to publishers, not to the academics who actually write scientific papers. And while some top journals do give researchers the option to make their submission free to read, they do this by reversing their fee structure, putting the burden on the author instead.</p>
<p id="CGGggp"><em>Nature,</em> for example, charges authors not affiliated with institutions <a href="https://www.science.org/content/article/9500-nature-journals-will-now-make-your-paper-free-read?cookieSet=1">roughly $9,500</a> to display a paper without the paywall. Given that grant-funded research is already far from profitable for the researchers themselves, this is a significant hurdle that disproportionately hits junior academics and those from lower-income countries. </p>
<p id="zsvD2m">But in a bid to tear down the paywall and make science more accessible to all, the White House last month announced <a href="https://www.whitehouse.gov/wp-content/uploads/2022/08/08-2022-OSTP-Public-Access-Memo.pdf">new guidelines</a> requiring that all taxpayer-funded research, including data used for a study, <a href="https://www.whitehouse.gov/ostp/news-updates/2022/08/25/ostp-issues-guidance-to-make-federally-funded-research-freely-available-without-delay/">be made public</a> at no cost by the end of 2025. </p>
<p id="K7ppAi">The Biden plan is one of the biggest wins yet for the “<a href="https://www.apa.org/science/about/psa/2019/02/open-science">open science</a>” movement. In practice, it often refers to publishing the papers that describe new scientific findings immediately and without paywalls. It can also include publicly sharing full datasets and code used for analysis. </p>
<p id="FB2tZd">The movement toward transparency and open-access science began with <a href="https://cshl.libguides.com/open_access/history_policy">1990s activism</a>, and reached the White House <a href="https://obamawhitehouse.archives.gov/blog/2013/02/22/expanding-public-access-results-federally-funded-research">in 2013</a> during the Obama administration, having been a force in US politics <a href="https://www.scientificamerican.com/article/open-access-to-science-un/">as early as 2007</a>. Biden’s interest in open science predates his presidency; in 2016, <a href="https://sparcopen.org/news/2016/vice-president-biden-calls-for-open-access-open-data-new-research-incentives-for-cancer-research/">he remarked</a> that “taxpayers fund $5 billion a year in cancer research every year, but once it’s published, nearly all of that taxpayer-funded research sits behind walls.” </p>
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<p id="CIFLBW">There’s a straightforward argument behind making publicly funded research available: Taxpayers are already paying to fund a study, so why should they also have to pay a fee to a journal to see the results? The hope is that making the latest data and research findings freely available will let scientists and entrepreneurs build more quickly on new discoveries, and members of the public will have a more accurate sense of the state of scientific knowledge. </p>
<p id="ffU8WM">But despite decades of advocacy for “open science,” the idea is far from universally accepted — and there isn’t even a consistent definition of what it means.</p>
<h1 id="GHbc5c"><strong>The origins of “open science”</strong></h1>
<p id="WSdzSg">The push for open science — and the pushback — didn’t begin with the US, and past international efforts can hint at how the new guidelines are likely to play out. </p>
<p id="a4VA4A">In 2018, <a href="https://www.tue.nl/en/research/researchers/robert-jan-smits/">Robert-Jan Smits</a>, who was then a senior adviser for open access and innovation at the <a href="https://en.wikipedia.org/wiki/European_Political_Strategy_Centre">European Political Strategy Centre</a>, founded a movement to open up access to science, <a href="https://sparcopen.org/our-work/innovator/robert-jan-smits-plan-s/">taking advantage</a> of growing support in Europe. He recruited a <a href="https://www.coalition-s.org/organisations/">number of influential funders</a> to require that grant recipients make their research public, even though it was a <a href="https://www.nature.com/articles/d41586-022-00717-z">radical departure</a> from the previous paywall-based European standards for <a href="https://link.springer.com/article/10.1007/s11192-017-2332-z">academic publication</a>.</p>
<p id="JjVSpF">In their recently published, free-to-download book, <a href="https://library.oapen.org/handle/20.500.12657/52946"><em>Plan S for Shock</em>,</a> Smits and co-author Rachael Pells argue that science will be more successful as an international, collaborative effort, but that currently, scientists in poorer countries are <a href="https://theconversation.com/how-academic-journals-price-out-developing-countries-2484">shut out</a> by high access fees.<strong> </strong>For society to reap the full benefit of new discoveries, the results need to be available to everyone, not just academics. </p>
<p id="zBGg7M">While open-access papers show a small if inconsistent <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253129">increase in citations</a> from other scientists, compared to paywalled research, this massively understates the real impact: A <a href="https://zenodo.org/record/4143313#.Yw_QapDMKup">Dutch survey</a> by<em> </em><a href="https://www.springernature.com/gp"><em>Springer Nature</em></a> found that 40% of visitors to their open-access site weren’t academics, and simply had personal or professional interest in a topic. </p>
<p id="ON0FJ9">Under <a href="https://www.coalition-s.org/">Plan S</a>, which went <a href="https://www.science.org/content/article/new-mandate-highlights-costs-benefits-making-all-scientific-articles-free-read">into effect</a> in 2021 in 12 European countries, scientists receiving grant money from an affiliated funder would, as a condition of that funding, make their findings <a href="https://en.wikipedia.org/wiki/Open_access">open access</a>. They could post to a <a href="https://www.editage.com/insights/5-scholarly-open-access-publishers-that-are-accelerating-science">free public repository</a>, like <a href="https://www.openaire.eu/zenodo-guide#:~:text=Free%20to%20upload%20and%20free,appropriate%20institutional%20or%20thematic%20repository%3F">Zenodo</a> and <a href="https://arxiv.org/about">arXiv</a>, or <a href="https://blog.scielo.org/en/2013/09/18/how-much-does-it-cost-to-publish-in-open-access/#.Yw_u65DMI-Q">pay a fee</a> to a conventional journal. Universities would often negotiate deals directly with publishers to cover these fees, while <a href="https://www.springernature.com/gp/open-research/funding/articles#List_of_funders">some funders</a> introduced their <a href="https://www.opensocietyfoundations.org/newsroom/new-grants-program-promote-open-access-publishing">own programs</a> to cover submission fees for research they funded. </p>
<p id="Gwzc9I">Biden’s new plan will have similar requirements, but applied to the huge number of researchers and universities that receive funding from the US federal government, which covers almost <a href="https://www.nytimes.com/2022/08/25/us/white-house-federally-funded-research-access.html">400 different organizations and agencies</a>. The <a href="https://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=137797">transition is set to be complete</a> by the end of 2025. </p>
<h1 id="LLf5wn"><strong>Why some want science closed</strong></h1>
<p id="FXXC8R">Freeing research largely paid for by taxpayer money can seem like a no-brainer, but over time, the <a href="https://www.nature.com/articles/d41586-022-00724-0">potential downsides</a> of open science efforts like the Plan S mandate have become more apparent. While pay-to-publish but free-to-read platforms bring more research to the public,<em> </em>they can add barriers for researchers and <a href="https://www.americanscientist.org/article/open-science-isnt-always-open-to-all-scientists">worsen some existing inequalities</a> in academia. Scientific publishing will remain a <a href="https://www.theguardian.com/science/2017/jun/27/profitable-business-scientific-publishing-bad-for-science">for-profit industry</a> and a <a href="https://www.newscientist.com/article/mg24032052-900-time-to-break-academic-publishings-stranglehold-on-research/">highly lucrative</a> one for publishers. Shifting the fees onto authors doesn’t change this.</p>
<p id="pePqbi">Many of the newly founded <a href="http://oad.simmons.edu/oadwiki/OA_journal_business_models">open-access journals</a> drop the fees entirely, but even if they’re not trying to make a profit, they still need to cover their operating costs. They fall back on <a href="https://journals.uic.edu/ojs/index.php/fm/article/view/2777/2478">ad revenue</a>, individual <a href="https://quod.lib.umich.edu/j/jep/3336451.0018.307?view=text;rgn=main">donations</a> or philanthropic <a href="https://gatesopenresearch.org/">grants</a>, <a href="https://www.sspnet.org/events/past-events/annual-meeting-2017/sponsors/">corporate sponsorship</a>, and even <a href="https://www.econtentpro.com/blog/crowdfunding-for-open-access-publications/224">crowdfunding</a>. </p>
<p id="2MShrW">But open-access platforms often lack the prestige of well-known top journals like <em>Nature</em>. Scientists early in their careers — as well as those at <a href="https://peerj.com/articles/4269/">less wealthy universities</a> in <a href="https://blogs.lse.ac.uk/impactofsocialsciences/2020/10/23/open-science-who-is-left-behind/">low-income countries</a> — often rely on <a href="https://theconversation.com/dependent-and-vulnerable-the-experiences-of-academics-on-casual-and-insecure-contracts-118608">precarious, short-term</a> grant funding to carry out their research. Their <a href="https://simplystatistics.org/posts/2016-04-11-publishing/">career</a> depends on putting out an impressive <a href="https://www.science.org/content/article/yes-it-getting-harder-publish-prestigious-journals-if-you-haven-t-already">publication record</a>, which is <a href="https://www.science.org/doi/10.1126/sciadv.1400005?adobe_mc=MCMID%3D63811730667095703321983054087886407551%7CMCORGID%3D242B6472541199F70A4C98A6%2540AdobeOrg%7CTS%3D1661992373&_ga=2.43871075.772758568.1661902972-791798531.1648755416">already an uphill battle</a>.</p>
<p id="MmuAz5">The established journals are reluctant to commit to open access, since submission fees may deter potential researchers from sending in their work. And if journals don’t charge submission fees or reader subscriptions, they’ll have to turn to other sources of income, which may be unsustainable in the long run. </p>
<p id="loeHpC">There are other ways that the open science movement might fail to live up to the optimistic claims of its advocates. So far, the movement is focused on publicly funded science; corporate R&D and privately funded research are exempt from the mandate. While supporting commercial <a href="https://wiki.lib.sun.ac.za/images/5/5c/Report-to-oauk-benefits-of-open-access.pdf">innovation and entrepreneurship</a> is one of the Biden administration’s explicit goals, <a href="https://academic.oup.com/eurpub/article/32/3/337/6562075">some groups</a> are concerned that the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8025975/">“commercialization”</a> of science will actually reduce transparency, and that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494677/">financial conflicts of interest</a> in commercially funded research will lead to <a href="https://link.springer.com/article/10.1007/s11606-018-4784-0">biased studies</a>. </p>
<p id="wl8lne">The open science movement’s influence is growing thanks to projects like Plan S, but exactly how far it reaches now is hard to measure. Their coalition of funders backed 200,000 new studies in 2020, making up <a href="https://www.nature.com/articles/d41586-021-00883-6">12% of articles</a> in the most-cited journals. </p>
<p id="BFQgpR">The White House guidelines will massively <a href="https://www.science.org/content/article/white-house-requires-immediate-public-access-all-u-s--funded-research-papers-2025">boost</a> adoption — the US government funded <a href="https://www.whitehouse.gov/wp-content/uploads/2022/08/08-2022-OSTP-Public-Access-Congressional-Report.pdf">195,000 to 263,000</a> studies in 2020 — but likely won’t be enough to shift the world of scientific publishing toward a new, more accessible paradigm. If science is really meant to serve the public interest, it should be in the public interest to make it available.</p>
<p id="9FQqxU"><em>A version of this story was initially published in the Future Perfect newsletter. </em><a href="https://confirmsubscription.com/h/d/A2BA26698741513A"><em><strong>Sign up here to subscribe!</strong></em></a></p>
https://www.vox.com/future-perfect/2022/9/18/23356630/open-science-academic-research-paywall-bidenMiranda Dixon-Luinenburg2022-08-14T08:00:00-04:002022-08-14T08:00:00-04:00Why monkeypox is a repeat of the data mistakes made with Covid-19
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<figcaption>A nurse documents a surgical patient’s information on a computer. | Getty Images</figcaption>
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<p>Accurate data is critical for public health, and the US doesn’t have it.</p> <p id="ll4jPk">The US <a href="https://www.nbcnews.com/health/health-news/us-officials-plan-declare-monkeypox-public-health-emergency-rcna40504?cid=ed_npd_bn_tw_bn">declared</a> monkeypox a public health emergency this month, but the decision may have come <a href="https://www.nbcnews.com/politics/white-house/white-house-scrambles-play-catch-monkeypox-response-rcna41305">too late</a>. Though states <a href="https://www.politico.com/news/2022/07/27/cdc-monkeypox-reportable-condition-00048188">are now required</a> to report cases, and <a href="https://www.hhs.gov/about/news/2022/06/22/hhs-expanding-monkeypox-testing-capacity-five-commercial-laboratory-companies.html">commercial labs</a> have an approved test, a <a href="https://www.wired.com/story/theres-a-monkeypox-testing-bottleneck/">testing bottleneck</a> persists, and cases — which passed 10,000 <a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html">confirmed cases</a> this week — are likely still being underreported. Any <a href="https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2022/07/28/monkeypox-straining-already-overstretched-public-health-system">effective</a> public health response to an infectious disease is dependent on having accurate data. If the virus spreads to other <a href="https://www.cdc.gov/poxvirus/monkeypox/specific-settings/congregate.html">populations</a>, such as college <a href="https://www.boston25news.com/news/local/is-monkeypox-next-infectious-issue-college-campuses/VP5MEVWUU5FKDMJ7XBFSU7WD4M/">dorms</a> — where cases have <a href="https://cbsaustin.com/news/local/ut-austin-health-officials-confirm-positive-monkeypox-case-in-the-community">already</a> <a href="https://www.wnep.com/article/news/local/union-county/bucknell-confirms-first-monkeypox-case-university-union-county-lewisburg-virus-isolate-student-health/523-d2f0e4e8-e802-4390-86bd-5bd5756ad9de">been</a> <a href="https://www.insidehighered.com/news/2022/08/05/colleges-prepare-potential-monkeypox-outbreaks">reported</a> — the testing bottleneck could ultimately make it impossible to contain the spread. Reliable demographic information is key to making the right choices for allocating limited tests and vaccines. </p>
<p id="Y9fw3K">All of this feels like an uncanny echo of the early mishandling of Covid-19. Limited access <a href="https://www.modernhealthcare.com/technology/covid-19-testing-problems-started-early-us-still-playing-behind">to testing</a>, a hobbled <a href="https://covidtracking.com/analysis-updates/federal-covid-19-test-data-is-getting-better">federal infrastructure</a> to track cases, and the <a href="https://covidtracking.com/analysis-updates/counting-covid-19-tests">general lack</a> <a href="https://www.fau.edu/newsdesk/articles/covid-state-responses.php">of communication</a> among different agencies and states <a href="https://www.science.org/content/article/us-epidemiologists-say-data-secrecy-covid-19-cases-cripples-intervention-strategies">complicated</a> the federal government’s ability to make evidence-based public health decisions. Reporting lags on rising cases meant that <a href="https://www.justsecurity.org/69650/timeline-of-the-coronavirus-pandemic-and-u-s-response/">lockdowns began</a> too late to save tens of <a href="https://www.nytimes.com/2020/05/20/us/coronavirus-distancing-deaths.html">thousands</a> of lives. Similarly, certain communities uniquely at risk, like Black and Hispanic people who lacked access to health care, were <a href="https://news.weill.cornell.edu/news/2022/04/racism-revealed-in-covid-19-outcomes-disparities-state-health-commissioner-says">suffering higher rates</a> of severe illness and death from Covid before policymakers had any way of knowing where to direct <a href="https://www.ama-assn.org/delivering-care/public-health/covid-19-amas-recent-and-ongoing-advocacy-efforts">public health</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8389831/">outreach</a>. </p>
<p id="3a9LLV">But the roots of this deadly problem long predate monkeypox outbreaks or the Covid-19 pandemic. The US has always had a fragmented health care system, with widely disparate experiences for patients based on state, insurance company, or hospital chain. Without systems to reliably record and share population-level data between decision-makers, health care workers can’t focus on helping the patients who need it most. The consequences are worse for marginalized people — such as Indigenous people, people with disabilities, or youth at risk for teen pregnancy — who were already facing inadequate care before the pandemic. </p>
<p id="iHZcC1">It doesn’t have to be this way. The US has an opportunity to learn from the tough lessons of the last few years and build on work to improve transparency and data sharing. With monkeypox already a <a href="https://www.who.int/europe/news/item/23-07-2022-who-director-general-declares-the-ongoing-monkeypox-outbreak-a-public-health-event-of-international-concern">global public health emergency</a>, it’s vital for the data to be available, promptly and accurately, to coordinate an effective public health response. This is how we can get there.</p>
<h3 id="v1Wu9k">Why does data matter? </h3>
<p id="98pI4N">Evidence-based medicine — the practice of using observation, studies, and randomized controlled trials to test which treatments work<em> —</em> has <a href="https://elliotphysicians.org/roundup-major-medical-advances-of-the-20th-century/">transformed</a> the <a href="https://gohighbrow.com/20th-century-medicine/">medical field</a> over the last century. But for that to work, as Covid showed, you need to have data to inform medical decisions. </p>
<p id="0oGz96">The US has mandatory <a href="https://www.cdc.gov/nndss/about/conduct.html">reporting</a> systems for some <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/00001665.htm">contagious diseases</a>, along with public health concerns like <a href="https://www.cdc.gov/nceh/lead/default.htm">lead poisoning</a>. This usually means that hospitals, clinics, and laboratories are required to report the location, severity of the illness, and treatment provided for any confirmed case. They also must document demographic information, such as race and ethnicity.</p>
<p id="CpYcLS">But that reporting is hobbled by the fact that there is no single agency responsible for the US health care system. Data is collected by federal agencies such as the Department of Health and Human Services — which houses the CDC, the Food and Drug Administration, and the Indian Health Service — as well as the Federal Emergency Management Agency (FEMA), which focuses on supplies and infrastructure for disaster preparedness. But communication among these agencies, the state health departments that report to them, and the hospitals and organizations where data is collected <a href="https://www.brookings.edu/research/how-poor-communication-exacerbates-health-inequities-and-what-to-do-about-it/">is often challenging</a>, thanks to a fractured system made up of hundreds of different organizations. </p>
<p id="1x3jcH">Data comes in from <a href="https://www.definitivehc.com/blog/top-10-largest-health-systems#:~:text=How%20many%20health%20systems%20are,owned%20by%20a%20healthcare%20system.">over 900 health systems</a>, or chains of hospitals under shared management; the largest include about 200 hospitals. But that’s just a fraction of the <a href="https://www.aha.org/statistics/fast-facts-us-hospitals">over 6,000 hospitals</a> across the country. So when, for example, positive test results for Covid-19 or monkeypox, or cases of <a href="https://www.cdc.gov/niosh/topics/pesticides/">workplace exposure</a> to pesticides, have to be reported to the state, <a href="https://www.cdc.gov/publichealthgateway/healthdirectories/healthdepartments.html">public health boards</a> in every state must coordinate with hundreds of different organizations and aggregate their data before they can share it with federal agencies. Except during an officially declared public health emergency — which, for monkeypox, is only a week old — the CDC has <a href="https://www.cdc.gov/surveillance/projects/dmi-initiative/where_does_our_data_come_from.html">limited legal power</a> to mandate reporting.</p>
<figure class="e-image">
<img alt="A 3D rendering of the spread of Covid-19" data-mask-text="false" src="https://cdn.vox-cdn.com/thumbor/dyGqG0Q_Wx3lGWxcGOKx5boD_A4=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/23941464/GettyImages_1216889088.jpg">
<cite>Getty Images</cite>
<figcaption>A 3D rendering of the global spread of Covid-19.</figcaption>
</figure>
<p id="Nhk09G">Data also isn’t collected the same way everywhere. There is <a href="https://www.definitivehc.com/blog/most-common-inpatient-ehr-systems">a large number</a> of different electronic health record systems currently in use in the US. They allow medical professionals to document a patient’s diagnosis and treatment, and in theory, share them more efficiently than in the days of paper-based records. But the software systems aren’t designed to be compatible with each other, so they <a href="https://www.himss.org/resources/interoperability-healthcare">cannot easily exchange data</a>. </p>
<p id="ZFNfQE">Even for a popular software platform like <a href="https://www.epic.com/">Epic</a>, which <a href="https://www.beckershospitalreview.com/ehrs/ehr-vendors-ranked-by-percentage-of-hospital-market-share.html#:~:text=Epic%20remains%20the%20vendor%20that,EMR%20Market%20Share%202021%22%20report.">covers about a third</a> of hospital systems in the US, categories like a patient’s diagnosis — or even something as simple as their height or weight — are often customized for a particular hospital or chain. This makes for a <a href="https://blueehr.com/blogs/the-positive-impact-of-customizing-your-ehr/">more efficient workflow</a> for the medical professionals on the ground, but it means that every hospital or chain is collecting slightly different information and organizing it differently. In order to piece the information together into a national picture that policymakers can actually use, each individual dataset has to be mapped onto a standardized format, a massive administrative burden that adds to delays. </p>
<p id="83m1PI">For example, when I worked as a nurse in Canada, different hospitals in the same city used different recordkeeping software. Rather than digitally transferring data, other hospitals would fax a paper copy of their records, which had to be entered manually, leading to delay and data entry mistakes — and this was assuming that we knew the patient had been hospitalized there before. Getting the records of a patient’s medical history from primary care providers or clinics was even more challenging. It wasn’t uncommon for a single patient to end up with two or three duplicate charts, sometimes due to minor spelling errors in their name.</p>
<p id="aj0fcS">With hundreds of different organizations involved, it’s no wonder the US faces greater challenges in maintaining a complete and accurate national-level database than a country like the UK, with a <a href="https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-deaths/">centralized</a> single-payer <a href="https://www.expatica.com/uk/healthcare/healthcare-services/uk-hospitals-1095642/">health care</a> system. The sheer size and varied demographics of the US population add further challenges.</p>
<p id="BgsSLs"> “The United States is incredibly diverse in many ways,” is how <a href="https://yourlocalepidemiologist.substack.com/p/covid-19-and-monkeypox-similarities">epidemiologist Katelyn Jetelina</a> puts it. “You know, race, ethnicity, age, health status, state-level policies, rural, urban. There are so many [of what we call] confounders in epidemiology, so many important factors that will influence health and disease. What we see in New York City isn’t necessarily going to be generalizable or translatable to, for example, rural Texas.” </p>
<p id="C1n5xe">Until the US <a href="https://www.npr.org/2022/07/25/1113282334/monkeypox-outbreak-covid-lessons-epidemiologists">started using</a> <a href="https://www.medtechdive.com/news/commercial-labs-monkeypox-testing/626351/">commercial labs</a> to ramp up testing capacity for monkeypox in late June, samples could only be processed at <a href="https://emergency.cdc.gov/lrn/">state public health labs</a>, with a <a href="https://www.bloomberg.com/opinion/articles/2022-06-14/monkeypox-outbreak-us-repeated-its-mistakes-from-covid-response">cumbersome</a> process. Hot spots like New York were overstretched, while other states’ labs sat idle. The <a href="https://www.statnews.com/2022/06/07/testing-bottleneck-for-monkeypox-jeopardizes-containment-experts-warn/">delays</a> and <a href="https://www.nytimes.com/2022/07/18/nyregion/new-york-monkeypox-vaccine.html">poor coordination</a> between clinics and city health departments meant that contact tracing happened too late to contain the spread. If the spread had been caught earlier, patients would have been more likely to minimize their risk and seek out testing and treatment if they were exposed, and there would have been more advance warning on ordering a vaccine supply.</p>
<p id="K4BbVl">Undertesting doesn’t just affect the case numbers reported, but hurts patients’ access to treatment. Tecovirimat, or TPOXX, an antiviral drug that is most effective for treating monkeypox if started early, can’t be prescribed until a test <a href="https://www.cdc.gov/poxvirus/monkeypox/clinicians/Tecovirimat.html">comes back positive</a>, and since it’s not officially approved by the FDA for monkeypox treatment, doctors need to <a href="https://www.washingtonpost.com/health/2022/07/15/monkeypox-response-vaccine-treatment-obstacles-adams/">jump through bureaucratic hoops</a> to prescribe it. This leaves many patients suffering from untreated painful lesions for days or weeks. </p>
<p id="dOaWvA">As Jetelina pointed out in a Substack post, monkeypox <a href="https://yourlocalepidemiologist.substack.com/p/covid-19-and-monkeypox-similarities">doesn’t need</a> to go the same way that Covid did; it’s a known disease, with a vaccine already developed, and spreads via close contact rather than being airborne. But the slow initial response, disorganized due to lack of information, means that the window of opportunity to contain monkeypox <a href="https://caitlinrivers.substack.com/p/we-need-simple-transparent-metrics?utm_source=%2Fprofile%2F99891602-caitlin-rivers-phd&utm_medium=reader2">is closing</a>.</p>
<h3 id="WKYRYJ">Where do we go from here? </h3>
<p id="PSFXmt">However difficult the growing pains, there has been real progress made on data collection since the first US Covid-19 cases in early 2020. </p>
<p id="yPi39u">The <a href="https://ncats.nih.gov/n3c">National Covid Cohort Collaborative</a>, a project run by the National Institutes of Health’s <a href="https://ncats.nih.gov/">National Center for Advancing Translational Sciences</a> (NCATS)<strong> </strong>that gathers clinical data on Covid-19, was <a href="https://www.technologyreview.com/2021/06/21/1026590/us-covid-database-n3c-nih-privacy/">stood up</a> during the pandemic. Joni Rutter, NCATS’s acting director, describes the challenges they faced when combining hundreds of disparate data sources around the pandemic: “Even when you’re talking about height, one site will send us data in inches. One site will send it in centimeters.” </p>
<p id="FxaWXc">For more complicated questions, the process is even more fraught. <a href="https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html#:~:text=Some%20people%20who%20have%20been,(PCC)%20or%20long%20COVID.">Long Covid</a>, for example, is linked to more than 200 distinct symptoms of varying severity, but <a href="https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1">screening tools</a> generally include only some of these, their definitions vary between different hospitals and clinics, and doctors often won’t document every symptom a patient experiences. As a result, <a href="https://www.nature.com/articles/d41586-022-01702-2">estimates</a> on the risk of long Covid vary from as much as one in two Covid-19 cases to one in 20. It’s also particularly important for the Collaborative’s dataset to accurately reflect the diversity of the US population, a challenge their team has worked hard on. “It really helps us to get access to rural communities and more minority communities,” Rutter says. </p>
<aside id="8Nyv9n"><div data-anthem-component="newsletter" data-anthem-component-data='{"slug":"future_perfect"}'></div></aside><p id="2ef1Zj">The NIH’s efforts to build the Collaborative database in the right way were a major step forward, one that should be more widely adopted. More than 2,000 scientists are using the group’s centralized <a href="https://covid.cd2h.org/">database system</a> to ask critical questions about Covid, like rates of <a href="https://covid.cd2h.org/dashboard/public-health/reinfection/1">reinfection,</a> <a href="https://ncats.nih.gov/news/releases/2022/scientists-identify-characteristics-to-better-define-long-COVID">characteristics of long Covid</a>, and differences in outcomes between <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8644257/">urban and rural patients</a>. Meanwhile, the National Patient Safety Board, an advocacy group <a href="https://journals.lww.com/journalpatientsafety/Fulltext/2012/03000/An_NTSB_for_Health_Care___Learning_From.2.aspx">calling for a health care equivalent</a> of the National Transportation Safety Board, hopes to improve tracking of medical errors and use <a href="https://npsb.org/wp-content/uploads/2021/11/NPSB-Technology-Blueprint-1.pdf">machine learning</a> to find underlying causes. </p>
<p id="MnRsCr">Other organizations are working on cleaning up the data at its source. The <a href="https://www.nih.gov/arpa-h">Advanced Research Projects Agency for Health,</a> officially authorized in March 2022, is another NIH program based on the Defense Department’s famous research center DARPA, with the goal of promoting innovation and new technology in health care. Its initial work may include revamping electronic health records and letting hospitals <a href="https://www.medicaleconomics.com/view/challenges-switching-ehrs">migrate their data</a> over to new and improved systems. In its 2022 <a href="https://www.whitehouse.gov/covidplan/">National Covid-19 Preparedness Plan</a>, the White House <a href="https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/27/memorandum-on-restoring-trust-in-government-through-scientific-integrity-and-evidence-based-policymaking/">committed</a> to improving data infrastructure by scaling up electronic case reporting systems to cover all states, in order to better track case counts and hospitalizations and link these to vaccination rates. </p>
<p id="zRFqex">That isn’t enough, though. According to Karen Feinstein, spokesperson for the National Patient Safety Board, the entire approach to health care needs to change. One example to emulate could be the aviation industry; thanks to decades of recommendations from their <a href="https://www.ntsb.gov/about/history/Pages/default.aspx#:~:text=%E2%80%8B%E2%80%8B%E2%80%8B%E2%80%8B%E2%80%8B,it%20was%20created%20in%201940.">safety board</a>, which has scrupulously tracked airline data since 1967, accident and fatality rates in air travel <a href="https://www.bjtonline.com/business-jet-news/how-flight-safety-has-evolved">have fallen</a> <a href="https://thefearofflying.com/articles/why-commercial-flights-are-the-safest-way-to-travel/#:~:text=Advanced%20displays%2C%20global%20satellite%20positioning,once%20in%202%20million%20flights.">drastically</a>. </p>
<p id="JBLekN">“We have all kinds of technology to keep our pilots and passengers safe on airlines and our astronauts safe as they go to and from the space station,” she said. “We know that the answer is to build a better airplane or to build a better spaceship, and to have the pilots and astronauts do the things for which they are trained and prepared. The problem we have in health care is that we haven’t yet built a better airplane.” </p>
<p id="AaqU77">And building a “better airplane” for health care will involve reforming the current decentralized and fragmented recordkeeping. As Rutter sees it, “electronic health records need to evolve, and that’s going to be one of those things that I think we as a community, as consumers, need to help ensure does happen.” In the meantime, NCATS will continue with its current strategy of cleaning and combining the existing records. </p>
<p id="SLX3Ra">Jetelina believes that the federal agencies involved in public health responses need to be granted stronger legal authority to mandate standard reporting from states and hospital systems so they can come closer to the kind of constant surveillance the UK managed early on with Covid-19 <a href="https://www.cnbc.com/2022/05/31/britain-urges-people-with-monkeypox-to-abstain-from-sex-as-cases-rise.html">and with</a> <a href="https://www.bloomberg.com/news/articles/2022-07-27/what-the-uk-is-getting-right-in-the-fight-to-contain-monkeypox#xj4y7vzkg">monkeypox</a>. She thinks the key is to “take out a lot of this red tape and bureaucratic paperwork, at least during a public health emergency, [and] respond much, much quicker.”</p>
<p id="ubd40C">With monkeypox, the US can lean on the systems and infrastructure built during the Covid-19 pandemic, but some programs, like those that <a href="https://data.cdc.gov/Administrative/Claims-Reimbursement-to-Health-Care-Providers-and-/rksx-33p3">reimburse providers</a> for treating uninsured patients or provide free Covid-19 tests, vaccines, and antiviral drugs to <a href="https://www.kff.org/policy-watch/community-health-centers-are-a-key-source-of-covid-19-rapid-at-home-self-tests-for-hard-to-reach-groups/">community health centers</a>, were already <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/implications-of-the-lapse-in-federal-covid-19-funding-on-access-to-covid-19-testing-treatment-and-vaccines/">scaled down</a> after funding was decreased. In order to pull together a national response, the US needs <a href="https://caitlinrivers.substack.com/p/we-need-simple-transparent-metrics">straightforward, transparent data reporting</a> that can be compared and combined on a national level. </p>
<p id="Sq9mqO">The final difficulty will be in keeping this momentum going. The declaration of a new public health emergency for monkeypox will help <a href="https://www.bloomberg.com/news/articles/2022-08-04/us-declares-public-health-emergency-on-monkeypox-to-access-funds#xj4y7vzkg">keep federal funding</a> flowing toward projects like the new NCATS OpenData <a href="https://opendata.ncats.nih.gov/virus/monkeypox">portal</a> for monkeypox, but the need for better health care infrastructure won’t end when the emergency does. In a <a href="https://www.tfah.org/report-details/publichealthfunding2020/">chronically underfunded</a> public health system, short-term efforts <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/15/fact-sheet-consequences-of-lack-of-funding-for-efforts-to-combat-covid-19-if-congress-does-not-act/">may not</a> be enough. </p>
<p id="TUbojK">As Feinstein puts it, “the challenge we always have is something new that distracts the efforts toward reform, because we’ve gotten close to this in the past.” But with the lessons learned during the pandemic and new threats potentially on the horizon, she believes that “now is the time.” </p>
<p id="9T1q6Q"><strong>Correction, August 17, 4:20 pm: </strong>An earlier version of this article misidentified Joni Rutter’s job title. She is the acting director of the National Center for Advancing Translational Sciences (NCATS) program, which supports the work of the National Covid Cohort Collaborative. The article also originally misattributed the source of the monkeypox OpenData Portal. It is an initiative of NCATS.</p>
https://www.vox.com/future-perfect/2022/8/14/23302054/monkeypox-data-health-care-covid-collectionMiranda Dixon-Luinenburg2022-08-12T15:39:01-04:002022-08-12T15:39:01-04:00New York’s polio crisis, explained
<figure>
<img alt="A hand holding a small glass bottle with an elongated plastic top." src="https://cdn.vox-cdn.com/thumbor/IaEHh2wiUPCKwZq3GYRCjkrTmmk=/0x0:3467x2600/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71203253/GettyImages_1175760757a.0.jpg" />
<figcaption>A vial of the oral polio vaccine. | Ezra Acayan/Getty Images</figcaption>
</figure>
<p>How a polio case in New York — and genetic evidence of under-the-radar spread — affects US risk and global eradication efforts.</p> <p id="Z0mOkt">For the first time in almost a decade, a <a href="https://www.cidrap.umn.edu/news-perspective/2022/07/new-york-detects-vaccine-derived-polio-case">case of polio</a> was confirmed in the United States. Health officials in New York’s Rockland County discovered the case last month in an <a href="https://www.cnbc.com/2022/07/21/polio-case-confirmed-in-new-york-state-health-care-providers-told-to-look-for-more.html">unvaccinated 20-year-old</a>, decades after polio was eliminated from the US in <a href="https://www.cdc.gov/polio/what-is-polio/polio-us.html#:~:text=The%20United%20States%20has%20been,a%20threat%20in%20some%20countries.">1979</a>. On August 12, New York City health authorities <a href="https://www1.nyc.gov/site/doh/about/press/pr2022/nysdoh-and-nycdohm-wastewater-monitoring-finds-polio-urge-to-get-vaccinated.page">reported</a> that they had detected the polio virus in the local wastewater system, indicating that the virus was likely circulating under the radar in the city.</p>
<p id="m6ttXM">With the country and public health system already struggling under the weight of <a href="https://www.vox.com/covid-19-coronavirus-explainers">Covid-19</a> and <a href="https://www.vox.com/future-perfect/23282687/monkeypox-centers-for-disease-control-covid-world-health-organization-lgbtq">monkeypox</a>, this news comes as an unpleasant surprise, and instantly raises questions. How did this happen? Who else is at risk? What does it mean that the Rockland case was a <a href="https://health.ny.gov/press/releases/2022/2022-07-21_polio_rockland_county.htm">vaccine-derived strain</a>, and what are the implications for the global efforts to fully eradicate polio? </p>
<h3 id="ocOVRn">What is polio?</h3>
<p id="ESfhFJ">Polio, short for poliomyelitis, is caused by the poliovirus, an enterovirus that can infect the nervous system. Symptoms can range from those <a href="https://www.cdc.gov/polio/what-is-polio/index.htm">similar to the flu</a> (sore throat, fever, and fatigue), to a more severe infection of the spinal cord causing <a href="https://www.mayoclinic.org/diseases-conditions/meningitis/symptoms-causes/syc-20350508">meningitis</a> and even <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/flaccid-paralysis">paralysis</a>. But unlike the flu, the poliovirus multiplies mainly in the intestines, and it chiefly<strong> </strong>spreads when people don’t wash their hands after using the bathroom. Polio is <a href="https://indianexpress.com/article/explained/expert-explains-how-is-poliovirus-similar-to-coronavirus-7587517/">highly contagious</a>, at least to the unvaccinated, particularly in areas with <a href="https://www.unicef.org/sudan/stories/five-fast-facts-about-polio#:~:text=The%20wild%20poliovirus%20enters%20the,of%20poor%20hygiene%20and%20sanitation.">poor sanitation</a> and water safety. </p>
<p id="njBEbn">From the <a href="https://historyofvaccines.org/history/polio/timeline">first documented US outbreak in 1894</a> until vaccines were developed in the 1950s, polio was one of the most <a href="https://www.npr.org/sections/health-shots/2012/10/16/162670836/wiping-out-polio-how-the-u-s-snuffed-out-a-killer#:~:text=In%201952%20alone%2C%20nearly%2060%2C000,to%20keep%20polio%20victims%20alive.">feared childhood diseases</a>. Thousands of children were left <a href="https://www.who.int/news-room/fact-sheets/detail/poliomyelitis">paralyzed</a> with every summer outbreak. The most vulnerable were <a href="https://www.chop.edu/conditions-diseases/poliomyelitis-polio-children">children</a> under the age of 5.</p>
<p id="8mizor">But those victims were the exception; three-quarters of patients infected with the poliovirus show no symptoms at all. For most of the remaining quarter, the illness never progresses beyond <a href="https://www.cdc.gov/polio/what-is-polio/index.htm">flu-like symptoms</a>. In roughly one in 25 patients, however, the virus spreads to the nervous system and causes meningitis. About one in eight of the meningitis cases — or approximately 0.5 percent of total polio cases — will have permanent damage to their nerves that leaves them paralyzed. There was and is no known cure, only supportive treatments including the <a href="https://www.npr.org/2021/10/25/1047691984/decades-after-polio-martha-is-among-the-last-to-still-rely-on-an-iron-lung-to-br">iron lung</a> — since replaced by more advanced ventilators — and physical therapy. </p>
<p id="FbsVsC">The threat of polio changed permanently when two vaccines were discovered in short succession: an injected, inactivated vaccine by Dr. Jonas Salk in 1955, and a live-attenuated vaccine, taken orally, by Dr. Albert Sabin in 1961. Both vaccines are very effective, <a href="https://www.cdc.gov/vaccines/vpd/polio/index.html">granting 99 percent immunity to infection</a>. Sabin’s oral vaccine was eventually adopted widely in the US, and polio cases dropped drastically in the 1960s and 70s, until the wild virus was stamped out entirely in the country. </p>
<p id="9eN0lj">The US was ahead of the curve — a global vaccination campaign began in earnest in 1988, a few years after smallpox was declared eradicated in 1980. The US <a href="https://www.immunize.org/catg.d/p4215.pdf">switched</a> to the slightly safer inactivated, injected vaccine in 2000, and the shots are still recommended to all children on the <a href="https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html">standard childhood vaccine schedule</a>. Worldwide, thanks to <a href="https://polioeradication.org/who-we-are/">ongoing public health efforts</a>, hundreds of millions of children receive the oral vaccine every year, and the original wild virus has been driven out of all but a <a href="https://www.who.int/news-room/feature-stories/detail/pakistan-and-afghanistan-the-final-wild-poliovirus-bastion">handful of countries</a>. </p>
<h3 id="BteNf3">Where did this case come from? </h3>
<p id="7B8EYo">Since community spread of polio was eliminated from the US around 1980, all infections have come from other countries that still have the disease. <a href="https://health.ny.gov/press/releases/2022/2022-07-21_polio_rockland_county.htm">Genetic sequencing</a> shows that the recent case was a vaccine-derived poliovirus strain. This means the circulating virus isn’t from one of the few remaining pockets of endemic wild poliovirus, but rather from one of the many more countries with polio outbreaks that mutated from an oral, live-attenuated vaccine — which is not the vaccine currently used in the US. </p>
<p id="Ux16N8">Polio vaccines fit into one of <a href="https://www.hhs.gov/immunization/basics/types/index.html">two types</a>: inactivated or live-attenuated. <a href="https://www.sciencedirect.com/topics/immunology-and-microbiology/attenuated-vaccine">Live-attenuated vaccines</a>, like the combined <a href="https://www.cdc.gov/vaccines/vpd/mmr/public/index.html">measles, mumps, and rubella</a> vaccine recommended to all US children, contain a modified, weakened strain of a pathogen that doesn’t cause illness in humans, but still triggers an immune response that protects against the original strain. The oral vaccine used in the most at-risk countries is live-attenuated. Inactivated vaccines, like the polio vaccine currently used in the US, contain only dead virus material, and may need a <a href="https://www.healthcentre.org.uk/vaccine/advantages-disadvantages-inactivated-vaccines.html">longer series of booster shots</a> to stimulate the immune system enough to grant long-lasting and full immunity. </p>
<p id="htHJrA">Although the live-attenuated poliovirus vaccine almost never causes polio itself — except in the <a href="https://www.ncbi.nlm.nih.gov/books/NBK236293/">less than one in a million cases</a> when a child is severely immunocompromised — the fact that it contains a live virus inevitably carries some risk, unlike inactivated vaccines. When live-attenuated polio vaccines are given <a href="https://www.unicef.org/press-releases/polio-programme-accelerates-efforts-respond-new-polio-outbreaks-sudan-and-yemen">in a community</a> that contains a high fraction of unvaccinated people, the modified virus can infect others, and <a href="https://polioeradication.org/polio-today/polio-prevention/the-vaccines/opv/#:~:text=of%20the%20virus.-,Advantages,interrupting%20transmission%20of%20the%20virus">with enough</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4702576/">generations of spread</a>, it can — very rarely — mutate back into a new virulent strain. It’s essential to public health efforts to make sure enough people get vaccinated, to protect against both the wild virus and the possibility of new vaccine-derived strains. </p>
<p id="y6FsfU">Ironically, the fact that most polio cases are asymptomatic or mild — along with an incubation period that can <a href="https://www.health.ny.gov/press/releases/2022/2022-07-21_polio_rockland_county.htm">take up</a> to 30 days before symptoms appear — makes polio particularly challenging for contact tracing and public health containment efforts. The only way to keep the virus suppressed is by achieving herd immunity, which for polio requires <a href="https://www.yalemedicine.org/news/herd-immunity#:~:text=For%20polio%2C%20the%20threshold%20is,level%20and%20changes%20over%20time.">vaccinating about 80 percent of the population</a>. </p>
<h3 id="BEBCNR">Who is at risk? </h3>
<p id="41Sdgx">For most people in the US, the newly discovered polio case hasn’t raised the risk at all. Rockland County’s public health department believes that the patient is <a href="https://www.reuters.com/world/us/polio-case-found-new-york-city-suburb-state-agency-says-2022-07-21/">no longer contagious</a>. </p>
<p id="eRY6mn">The poliovirus can be <a href="https://www.cdc.gov/polio/what-is-polio/lab-testing/diagnostic.html#:~:text=Poliovirus%20can%20be%20detected%20in,Culture">detected in stool samples</a>, and also in <a href="https://www.cdc.gov/healthywater/surveillance/wastewater-surveillance/wastewater-surveillance.html#:~:text=Studying%20wastewater%20data%20can%20help,be%20used%20alongside%20other%20data.">wastewater monitoring</a>, which looks for evidence of viral genetic material in sewage. On August 1, the New York State Department of Health <a href="https://www.health.ny.gov/press/releases/2022/2022-08-01_polio.htm">reported</a> that the Rockland polio case was genetically linked to samples of the virus collected in <a href="https://polioeradication.org/news-post/report-of-polio-detection-in-united-states/">sewage</a> in Jerusalem and London, though the department stressed that the results do not automatically imply the patient had traveled to either location.<strong> </strong>The Rockland public health department was able to use sewage samples collected earlier for Covid-19 monitoring, and <a href="https://www.lohud.com/story/news/local/rockland/2022/07/26/polio-in-rockland-county-new-york-wastewater-in-june/65381908007/">found poliovirus in samples there<strong> </strong>from June</a> that are genetically connected to the current case. </p>
<p id="azEKPs">Given how common asymptomatic cases are and the long incubation period, it’s possible there are other unrecognized cases in the Rockland area. Those may still be infectious, but the odds are against it spreading far. As of 2019, <a href="https://www.cdc.gov/nchs/fastats/immunize.htm">over 90 percent of US children</a> were fully vaccinated against polio on schedule, well above the herd immunity threshold, and this figure has <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/00056803.htm">held steady for decades</a>. <a href="https://www.cdc.gov/vaccines/vpd/polio/hcp/routine-polio-vaccination.html">Infants 4 months or older</a> will usually have received two doses, which already <a href="https://www.cdc.gov/vaccines/vpd/polio/public/index.html">provides 90 percent immunity</a>. </p>
<p id="EjBTYR">Rockland County, though, has a lower vaccination rate than the rest of the country; it was the site of a <a href="https://www.cnn.com/2019/09/25/health/measles-outbreak-over-rockland-county-ny/index.html">2018-2019 measles outbreak</a>, and currently only <a href="https://www.northjersey.com/story/news/health/2022/07/22/risk-low-in-nj-from-polio-case-in-rockland-officials-say/65380823007/">60 percent of 2-year-olds</a> there are fully vaccinated against polio, compared to the national average of 90 percent. The <a href="https://health.ny.gov/press/releases/2022/2022-08-01_polio.htm">New York State Department of Health</a> is now urging all unvaccinated people, those who haven’t completed their polio vaccine series, and pregnant people to <a href="http://rocklandgov.com/departments/health/clinics-and-immunizations/">get vaccinated</a>. In the month since the polio case was discovered, the Rockland clinic administered <a href="https://patch.com/new-york/nyack/379-polio-vaccines-given-rockland-after-resident-left-paralyzed">almost 400 vaccine doses</a>. People in the Rockland area who were vaccinated as children but are worried they may have been exposed should schedule a booster shot. </p>
<p id="dacvCx">The new wastewater evidence that the polio virus may be circulating in New York City <a href="https://twitter.com/MarkLevineNYC/status/1558097373464764416?s=20&t=npr8lj1iXPzD-AIhs6rLZg">prompted health officials to urge</a> all unvaccinated New Yorkers to get polio shots as soon as possible. That’s especially true for young children, who are most vulnerable to polio — <a href="https://twitter.com/MarkLevineNYC/status/1558100792489426944?s=20&t=npr8lj1iXPzD-AIhs6rLZg">almost 14 percent</a> of New Yorkers between 6 months and 5 years old are unvaccinated, putting them at additional risk. </p>
<p id="GD05mb">Officials in London, where the polio virus has also been found in wastewater, have gone a step further, making all children between 1 and 9 years old <a href="https://www.npr.org/2022/08/10/1116749510/polio-london-children-vaccine-booster">eligible for polio booster shots</a>.</p>
<h3 id="8ZcUjt">What does this mean for the global eradication effort? </h3>
<p id="rbSw6h">While the US remains protected against polio, the same can’t be said of some more at-risk developing countries where the virus is still active. </p>
<p id="T6x5kn">After his work developing the oral vaccine, Sabin campaigned for a worldwide eradication effort in the 1960s, and in 1972 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636601/">donated all of his vaccine strains</a> to the World Health Organization in the hope of reducing the manufacturing cost. Despite recent efforts to introduce the slightly safer inactivated <a href="https://polioeradication.org/news-post/inactivated-polio-vaccine-now-introduced-worldwide/">vaccine worldwide</a>, most lower- and middle-income countries still <a href="https://polioeradication.org/polio-today/polio-prevention/the-vaccines/opv/">use the or</a><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572547/">al vaccine</a>. </p>
<p id="dDSSZZ">The <a href="https://polioeradication.org/who-we-are/">global eradication</a> <a href="https://www.who.int/news/item/24-06-2022-statement-of-the-thirty-second-polio-ihr-emergency-committee">program</a> has been a huge <a href="https://www.cdc.gov/polio/progress/index.htm">success</a> overall, with total <a href="https://www.immunize.org/askexperts/experts_pol.asp">worldwide polio cases declining</a> by more than 99.99 percent since the program started in 1988. But the <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7119a2.htm">closer</a> eradication gets, the harder <a href="https://www.npr.org/sections/goatsandsoda/2019/11/15/779865471/polio-vaccine-may-be-preventing-the-end-of-polio">reaching the finish line becomes</a>. When hundreds of millions of doses of oral vaccine are given every year, even the very low risk of a dose spawning a new vaccine-derived strain adds up. Most of the polio cases that have been detected in <a href="https://www.science.org/content/article/africa-battles-out-of-control-polio-outbreaks">African countries</a> like <a href="https://polioeradication.org/polio-today/polio-now/">Nigeria and Yemen</a> are <a href="https://www.science.org/content/article/africa-battles-out-of-control-polio-outbreaks">vaccine-</a><a href="https://polioeradication.org/polio-today/polio-prevention/the-virus/vaccine-derived-polio-viruses/">derived</a>. Interruptions in vaccination coverage due to <a href="https://www.cfr.org/backgrounder/why-hasnt-world-eradicated-polio">military conflicts</a> and the <a href="https://www.science.org/content/article/we-have-no-choice-pandemic-forces-polio-eradication-group-halt-campaigns">Covid-19</a> <a href="https://www.who.int/news/item/22-05-2020-at-least-80-million-children-under-one-at-risk-of-diseases-such-as-diphtheria-measles-and-polio-as-covid-19-disrupts-routine-vaccination-efforts-warn-gavi-who-and-unicef">pandemic</a> likely increased the risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240990/">vaccine-derived variants</a> spreading unchecked. </p>
<p id="FmPZJl">Despite the risks inherent to live-attenuated vaccines, the oral vaccine has significant advantages, particularly for public health campaigns in developing countries. Each dose costs as little as <a href="https://polioeradication.org/polio-today/polio-prevention/the-vaccines/opv/#:~:text=of%20the%20virus.-,Advantages,interrupting%20transmission%20of%20the%20virus">12 cents</a>, compared to about <a href="https://www.unicef.org/supply/media/7886/file/IPV-price-update-April-2021.pdf">$2 per dose</a> for the inactivated vaccine, and because it’s given in drops under the tongue, it doesn’t require needles or trained professionals to administer. Live-attenuated vaccines in general also provide stronger and longer-lasting immunity than inactivated vaccines. </p>
<p id="fR2Qdf">And early on, the infectiousness of the oral vaccine strain was actually considered a plus, since children not reached by health workers could potentially catch the weakened strain from others, ending up immune. In theory, as long as the vaccination campaign reached enough people in the community, the spread would fizzle out long before the virus had a chance to mutate back to virulence in humans. </p>
<p id="tCupMj"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168953/">Phasing out the oral vaccine</a>, which would eliminate the source of new polio variants, will likely be needed to reach full eradication, but replacing the oral vaccine with the full schedule of booster shots needed to grant immunity isn’t yet possible. Even if the funding and personnel were available, the total global supply of inactivated vaccines is <a href="https://www.npr.org/sections/goatsandsoda/2019/11/15/779865471/polio-vaccine-may-be-preventing-the-end-of-polio">far too low</a> to cover the hundreds of millions of children still at risk. </p>
<p id="fLlyh4">With monkeypox having been <a href="https://www.vox.com/science-and-health/2022/7/23/23171631/who-monkeypox-pheic-public-health-emergency-world-health-organization-pheic">recently declared a public health emergency</a> of international concern by the WHO, and the ever-present <a href="https://www.vox.com/22937351/next-pandemic-vaccine">threat of future pandemics</a> on the horizon, the global effort against polio is more important than ever to ensure that polio will never again be that kind of worldwide threat. <a href="https://time.com/6199846/polio-vaccine-kids-us/">Maintaining</a> and <a href="https://www3.paho.org/hq/index.php?option=com_content&view=article&id=14748:countries-of-the-americas-urged-to-take-action-to-keep-polio-at-bay&Itemid=1926&lang=en">ideally increasing</a> the vaccination rate in the US will protect the country in the meantime, and support the worldwide push for eradication by denying polio a foothold.</p>
<p id="r7piJa"><em><strong>Update, August 12, 11:25 am: </strong></em><em>This story was originally published on August 3 and has been updated to reflect news about polio virus found in wastewater in New York and London.</em></p>
https://www.vox.com/future-perfect/23288366/polio-rockland-vaccines-new-york-explainer-eradicationMiranda Dixon-Luinenburg2022-07-13T07:00:00-04:002022-07-13T07:00:00-04:00America has an innovation problem. The H-1B visa backlog is making it worse.
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<p>America needs high-skilled immigrants. Here’s why we don’t have more. </p> <p id="VjOfqS">Since the early 20th century, the US has been a <a href="https://hbr.org/2017/03/when-america-was-most-innovative-and-why">world leader</a> in innovation and technical progress. In recent decades, however, some experts have worried that the country’s performance on <a href="https://web.stanford.edu/~chadj/IdeaPF.pdf">these</a> <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3822691">fronts</a> has been <a href="https://hbr.org/2019/11/why-the-u-s-innovation-ecosystem-is-slowing-down">slowing</a>, even stalling. </p>
<p id="aBz0LS">There are many possible explanations for this phenomenon, but one has seemed especially salient in recent years: an immigration system that discourages, and often turns away, the most highly skilled and talented foreign workers. </p>
<p id="u0MWls">Historically, immigrants have played a vital role in American innovation. As <a href="https://progress.institute/author/jeremy-neufeld/">Jeremy Neufeld</a>, an immigration policy fellow with the Institute for Progress, a new innovation-focused think tank, remarked to me, “It’s always been the case that immigrants have been a secret ingredient in US dynamism.” <a href="https://www.mercatus.org/publications/immigration/effects-immigration-entrepreneurship-and-innovation">Robert Krol</a>, a professor of economics with California State University Northridge, describes it this way: “The bottom line is that when you look at the impact of immigrants — whether you think about starting businesses or innovating patents — they have a large, significant impact.” </p>
<p id="RXF0Br"><a href="https://www.nber.org/system/files/working_papers/w27075/w27075.pdf">Multiple</a> <a href="https://www.nber.org/papers/w27778">analyses</a> of historical immigration patterns show that more migrants to a region correlates with a higher rate of innovation and related economic growth. By contrast, when immigration is more <a href="https://www.mercatus.org/publications/trade-and-immigration/unintended-consequences-restrictions-h-1b-visas">restricted,</a> companies — especially <a href="https://www.newamericaneconomy.org/wp-content/uploads/2014/06/pnae_h1b.pdf">tech companies</a> and those that <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2534712">conduct innovative R&D work</a> — are <a href="http://qcpages.qc.cuny.edu/~fortega/research/h1b_coping2022.pdf">less successful</a>, and <a href="https://nfap.com/wp-content/uploads/2020/05/The-Impact-of-H-1B-Visa-Holders-on-the-U.S.-Workforce.NFAP-Policy-Brief.May-2020.pdf">growth in jobs and wages</a> slows. Studies have also shown that immigrants tend to be <a href="https://www.mercatus.org/system/files/krol_-_working_paper_-_what_do_we_know_about_the_impact_of_immigration_on_entrepreneurship_innovation_and_the_labor_market_-_v1.pdf">entrepreneurial</a>: Based on <a href="https://www.nber.org/system/files/working_papers/w24494/w24494.pdf">survey data between 2008 and 2012</a>, 25 percent of companies across the US were founded by first-generation immigrants. <a href="https://pubs.aeaweb.org/doi/pdfplus/10.1257/mac.2.2.31">Other</a> <a href="https://web.stanford.edu/~diamondr/BDMP_2019_0709.pdf">research</a> shows that immigrants are more likely than native-born US citizens to register patents. </p>
<p id="LnNngf">As <a href="https://progress.institute/immigration-powers-american-progress/">Neufeld points out</a>, the Covid-19 pandemic might have gone much worse if immigration had always been as restrictive as it is now. A number of co-founders and critical researchers with Moderna are immigrants, as is <a href="https://www.nytimes.com/2021/04/08/health/coronavirus-mrna-kariko.html">Katalin Karikó</a>, a <a href="https://www.npr.org/2020/12/18/947638959/if-covid-19-vaccines-bring-an-end-to-the-pandemic-america-has-immigrants-to-than">pioneer</a> of <a href="https://ge.usembassy.gov/katalin-karikos-research-led-to-covid-19-vaccines/">mRNA research</a> — who, if she had tried to immigrate after the 1990 H-1B reforms to the skilled guest worker program, might not have been able to come to the US at all. </p>
<p id="9TrV2J">Those H-1B guest visas are at the center of the issue today, some<strong> </strong>experts say. <a href="https://www.americanimmigrationcouncil.org/research/h1b-visa-program-fact-sheet">Designed in 1990</a> to bring in skilled professionals to meet labor market shortages, visas through the H-1B guest workers program are sponsored by employers, who submit petitions to bring in particular foreign professionals <a href="https://www.immigrationhelp.org/learning-center/what-is-the-h-1b-visa#:~:text=Who%20qualifies%20for%20an%20H,equivalent%20degree)%20in%20your%20field.">appropriately qualified for specific, highly skilled roles</a>. Guest workers generally need at least a bachelor’s degree in a relevant field. </p>
<p id="jaINlZ">According to the United States Citizenship and Immigration Services (USCIS), there are about <a href="https://www.uscis.gov/sites/default/files/document/reports/USCIS%20H-1B%20Authorized%20to%20Work%20Report.pdf">580,000 foreign workers</a> currently on H-1B visas, a small percentage of the US workforce and immigrant population. But they are disproportionately concentrated in STEM, particularly computer-related occupations, often in fields where cutting-edge technologies are being developed. </p>
<p id="LmFn4w">Unfortunately, the H-1B process is falling increasingly out of date and badly failing to serve its original purpose of turning on the talent tap for top innovative companies. Congress <a href="https://www.americanimmigrationcouncil.org/research/h1b-visa-program-fact-sheet">sets an annual cap</a> on how many H-1B visa holders can come in, and that cap is now far below what the labor market demands. The crush of applications once the window opens for a given year on March 1 is so intense that, in every year since 2014, USCIS has resorted to a lottery system instead of a first-come, first-serve process. That means that year in and year out, hundreds of thousands of high-skilled workers from abroad try to come to the US and ultimately fail, so that both the prospective employee and the company hoping to hire them end up losing out on their preferred option.</p>
<p id="ulvaP1">That shortfall is a policy problem. The US has long been a desirable destination for young, highly educated foreign workers eager to seek out the best career opportunities. Facing a longstanding <a href="https://www.usnews.com/news/best-countries/articles/2018-08-23/americans-think-they-have-a-shortage-of-stem-workers">shortage</a> of skilled STEM workers, US companies and the overall US economy stand to benefit. But the country risks losing its position to others like the <a href="https://www.gov.uk/guidance/new-immigration-system-what-you-need-to-know">UK</a> or <a href="https://www.canada.ca/en/immigration-refugees-citizenship/news/2022/02/new-immigration-plan-to-fill-labour-market-shortages-and-grow-canadas-economy.html">Canada</a>, which have made recent immigration reforms aimed at attracting and retaining high-skilled young people, if the US continues to restrict skilled immigration so heavily. </p>
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<cite>Hannah Yoon/Bloomberg via Getty Images</cite>
<figcaption>Katalin Kariko, a Hungarian biochemist, came to the US as an immigrant and helped develop mRNA vaccines.</figcaption>
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<p id="MbTQxq">As with many policy problems, there are some nuances here to pay attention to, not least the potential effect any policy changes might have on native-born US workers. And this discussion doesn’t touch on the debate over lower-skill guest workers vital to the US economy and the policies surrounding them. (That’s related, but beyond the scope of this story.) But there is little doubt that from the perspective of speeding innovation, the US system needs fixing. </p>
<p id="8buftk">“The big picture is that our ability to recruit talent is directly related to our economic success as a country,” economist <a href="https://www.cato.org/people/david-j-bier">David Bier</a>, associate director of immigration studies with the libertarian Cato Institute, told me. “We don’t know which [immigrant] is going to have the brilliant insight that totally transforms the economy over the next 20-30 years.”</p>
<h3 id="aQuMq6">Why the H-1B system is failing </h3>
<p id="uPI1ak">The H-1B visa is a three-year temporary work visa that is generally renewable once for three years. It’s not in itself a path toward permanent residency. (H-1B holders, however, can begin the process of getting a green card to stay in the US for good while already in the country as a guest worker.)</p>
<p id="yhdaQL">Currently, the annual cap is set at 65,000 visas, with an additional 20,000 slots allocated for workers with graduate degrees from US universities. That’s significantly down from the cap set in the early 2000s of 195,000 annually. </p>
<p id="zHpeCR">In the 1990s and early 2000s, USCIS accepted petitions on a first-come, first-serve basis until the annual cap was met. In most years, when the total applications eventually maxed out the cap, it inevitably left out many highly valuable potential immigrants or delayed their visa by a year, but at least the process allowed companies some opportunity to prioritize applying earlier in the annual window for employees they saw as more critical. </p>
<p id="6DRUMQ">In 2014, the annual H-1B applications <a href="https://redbus2us.com/h1b-visa-cap-reach-dates-history-graphs-uscis-data/">began spiking</a> and the volume of applications received just in the first few days of the window prompted USCIS to switch to a lottery system. For fiscal year 2023, only <a href="https://www.uscis.gov/working-in-the-united-states/temporary-workers/h-1b-specialty-occupations-and-fashion-models/h-1b-electronic-registration-process">26 percent of the 483,000 applications received</a> — more than double the 201,000 petitions submitted for 2020 — were chosen for processing. </p>
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<p id="BQh7gH">That level of restriction has hit the computer and software sector the hardest. The US has faced a shortage of qualified experts in computer-related occupations since the beginning of the H-1B program. Despite heavy investment in STEM programs at US universities, many companies claim they struggle to meet their hiring needs, especially in computer-related specialties; as a result, software engineers and programmers from overseas are in high demand by American companies.</p>
<p id="uVodSr">A <a href="https://nfap.com/wp-content/uploads/2020/05/The-Impact-of-H-1B-Visa-Holders-on-the-U.S.-Workforce.NFAP-Policy-Brief.May-2020.pdf">study</a> by the National Foundation for American Policy, a nonprofit that carries out public policy research on trade and immigration, found that between 2005 and 2018, more than half of all H-1B visas were granted to workers in computer-related occupations, even though the field represents barely more than 5 percent of the total workforce. Economist <a href="https://www.hks.harvard.edu/publications/immigration-and-regional-specialization-ai">Gordon Hanson</a> finds that foreign-born workers represent 55 percent of the job growth in AI-related work — a small subset of total jobs in computer-related occupations, but an area with rapid innovation — since 2000. </p>
<p id="SxSFMP">Other STEM fields are also affected by the H-1B crunch. Biology and engineering, as well as teachers in higher education, are overrepresented in H-1B applications. It seems likely that many of these workers’ petitions are losing out in the lottery, pushed out by the huge numbers of IT-related applications. </p>
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<p id="5xiDLw">One more problem afflicts the system. The H-1B program was originally envisioned as a short-term guest worker program, and the many skilled foreign professionals who want to permanently migrate and settle in the US were supposed to transition onto an immigrant visa offering a route to permanent residency — usually one of the <a href="https://travel.state.gov/content/travel/en/us-visas/immigrate/employment-based-immigrant-visas.html">employment-based visas</a> — as their next option. </p>
<p id="J0rft4">However, a lengthy backlog in the employer-sponsored green card pipeline — caused by the fact that new annual applications have exceeded slots for some time — means that approximately <a href="https://www.cato.org/blog/14-million-skilled-immigrants-employment-based-green-card-backlogs-2021">1.4 million H-1B workers</a> are currently waiting in line to apply for permanent residency, even as their visas are tied to their current employer. In tech fields, it’s common for employees to change jobs as they seek out the best opportunities, so the current system can severely limit a worker’s economic and career prospects. </p>
<p id="RIlaCU">As Bier puts it, “People get trapped in these wage tiers that are not appropriate for their skill set because ultimately the green card backlog decides whether they get a promotion or whether they can move to another company.” </p>
<p id="VlDkOg">For Indian guest workers, the current backlog <a href="https://www.cato.org/blog/14-million-skilled-immigrants-employment-based-green-card-backlogs-2021">is up to 90 years</a>, and an estimated 200,000 <a href="https://www.wsj.com/articles/adult-children-of-work-visa-recipients-forced-to-return-to-parents-countries-11654596000?mod=hp_lead_pos10">children of immigrants</a> waiting in the permanent residency pipeline face the threat that they will age out of their family-based eligibility when they turn 21, leaving them with no route to legally stay in the country. Bier’s analysis estimates that 215,000 petitions will expire with the applicant’s death before ever being processed. </p>
<h3 id="E7kLhv">The downsides of the H-1B system </h3>
<p id="BphAud">One unintended consequence of the current H-1B system that experts have flagged is the massive success of a particular business model: offshore “outsourcing” companies, mainly based in India. Outsourcing companies can put in thousands of H-1B petitions for workers they consider interchangeable, mainly junior programmers, and profit by sending the applicants who win the lottery to work for US-based companies as agency contractors. </p>
<p id="rsFuvZ">This model is popular enough that outsourcing companies make up a substantial percentage of all H-1B petitions filed. According to <a href="https://www.epi.org/people/ron-hira/">Ron Hira</a>, a research associate with the progressive Economic Policy Institute (EPI), <a href="https://www.epi.org/blog/the-h-1b-visa-program-remains-the-outsourcing-visa-more-than-half-of-the-top-30-h-1b-employers-were-outsourcing-firms/">17 of the top 30 companies</a> by annual H-1B applications are outsourcing firms. </p>
<p id="DuQAOB">There are several ways this could harm US workers, US companies, or innovation overall. One concern is that the “outsourcing” firms hold enormous leverage over their employees, effectively having a monopoly on their employment, and could thus <a href="https://www.epi.org/publication/new-evidence-widespread-wage-theft-in-the-h-1b-program/">exploit and underpay them</a>, potentially undercutting US workers’ salaries. </p>
<p id="niNH70">There is an ongoing debate about whether this is happening. <a href="https://www.epi.org/publication/h-1b-visas-and-prevailing-wage-levels/">According to EPI,</a> the local median wage for an occupation should be a minimum bound for H-1B workers, and with two of the wage tiers below the median, companies can use the H-1B for “wage arbitrage” and hire lower-paid foreign employees at the expense of US citizens.</p>
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<cite>Spencer Platt/Getty Images</cite>
<figcaption>People watch a video message from President Joe Biden as they participate in a special Memorial Day naturalization ceremony on June 1, 2022, in New York City.</figcaption>
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<p id="gKmIfT">But while there are some high-profile examples of US workers being laid off en masse and <a href="https://www.axios.com/2019/12/29/trump-att-outsourcing-h1b-visa-foreign-workers">replaced by agency workers</a>, a number of different economic data analyses — though certainly<strong> </strong><a href="https://gspp.berkeley.edu/assets/uploads/research/pdf/h1b.pdf">not all</a> — show little if any large-scale negative effect on US workers’ job opportunities or wages. A study by the <a href="https://www.cato.org/blog/100-h-1b-employers-offer-average-market-wages-78-offer-more">Cato Institute</a> shows that 100 percent of H-1B employers pay at least average market wages, and often more. </p>
<p id="LYkpsf">As <a href="https://webapps.unf.edu/faculty/bio/n01388128">Madeline Zavodny</a>, professor of economics at the University of North Florida, told me, “What you hear often from workers unions and so on is that, in their view, the ready availability of relatively low-wage young immigrant workers coming in on these H-1B visas reduces job opportunities and wages for competing US natives, particularly those who have been in the occupations for a while.” But, she added, “there’s not a whole lot of evidence to back that up.” If, as claimed by <a href="https://cacm.acm.org/news/253242-facing-shortage-of-high-skilled-workers-employers-are-seeking-more-immigrant-talent-study-finds/fulltext?mobile=false">many</a> <a href="https://www.daxx.com/blog/development-trends/software-developer-shortage-us">companies</a> and <a href="https://www.newamericaneconomy.org/issues/innovation-stem-fields/">economists</a>, there’s a real shortage of native workers in computer-related occupations, we wouldn’t expect to see much displacement or wage undercutting. </p>
<p id="9ltSRA">According to a policy brief that Zavodny wrote for the National Foundation for American Policy, wage data <a href="https://nfap.com/wp-content/uploads/2020/05/The-Impact-of-H-1B-Visa-Holders-on-the-U.S.-Workforce.NFAP-Policy-Brief.May-2020.pdf">collected</a> and analyzed via multiple different methodologies mainly shows the opposite: More foreign guest workers in a given occupation and region tends to result in salaries increasing faster in those places and job classes, likely due to general economic growth and innovation. </p>
<p id="ffofo1">Another concern with the current system is that the incentives it has created work against the goal of encouraging innovation. Because outsourcing firms are pouring tens of thousands of applications into the total “pot,” highly innovative US-based companies <a href="http://qcpages.qc.cuny.edu/~fortega/research/h1b_coping2022.pdf">face lower odds</a> of obtaining an H-1B for a specific employee. Under the system, a world-class expert in a niche field is treated exactly like a newly graduated junior employee, which makes it much harder for companies to bring in those experts who could do the most transformative work, especially when <a href="https://www.axios.com/2017/12/15/the-ripple-effects-of-trumps-h-1b-visa-reform-1513300214">outsourcing firms</a> are putting in thousands of applications annually. </p>
<p id="k7SaNt">As <a href="https://www.nber.org/people/francesc_ortega?page=1&perPage=50">Francesc Ortega</a>, a professor of economics at Queens College, puts it, “A company could have a wonderful case to make for why they [need] that particular Chinese engineer. Maybe they are about to develop the vaccine that will cure everything, but they need that guy, and everyone looking at the petition would be able to say, ‘Yeah, definitely, these guys should be top priority.’ But that mechanism doesn’t exist.” </p>
<h3 id="BtYLq9">Can incremental change fix a broken system? </h3>
<p id="5jpyoP">How then to create that mechanism and reconstruct the US’s high-skilled immigration system to bring in the world’s top talent while also minimizing potential harms to US workers? The Biden administration <a href="https://www.pewresearch.org/fact-tank/2022/01/11/key-facts-about-u-s-immigration-policies-and-bidens-proposed-changes/">has promised</a> to reform the system, and policy thinkers have proposed solutions, none of them perfect. </p>
<p id="W9JP1o">One idea came from the Trump administration. In 2020, then-President Trump proposed replacing the lottery with a <a href="https://www.shrm.org/ResourcesAndTools/hr-topics/talent-acquisition/pages/uscis-proposes-replacing-h1b-lottery-salary-based-selection.aspx">salary-based</a> ranking system. That is, rather than using a lottery to select candidates, USCIS would rank the petitions based on the salary offered by the employer, and start processing at the highest-salary end until the cap was reached. Such a system would in theory prioritize the most skilled and qualified candidates over the more junior workers. That would help innovative companies bring in the most valuable domain experts who play critical roles in their cutting-edge research, rather than being pushed out by outsourcing companies’ huge numbers of applicants. </p>
<p id="0X83C1">However, Zavodny told me she’s concerned this system would disproportionately disadvantage young recent graduates, many of whom are very driven to come to the US. Some other concerns include the fact that pay gaps <a href="https://www.pewresearch.org/fact-tank/2016/07/01/racial-gender-wage-gaps-persist-in-u-s-despite-some-progress/">along racial and gender-based lines</a> are still a problem in the US; a salary-based system could risk disproportionately shutting out those groups affected by salary bias. And as the <a href="https://www.governing.com/archive/gov-cost-of-living-regions.html">cost-of-living gap between regions in the US continues to increase</a>, a system that failed to adequately correct for this in the salary ranking might make it difficult for companies in areas with a lower cost of living to get petitions approved. In any case, <a href="https://www.shrm.org/ResourcesAndTools/hr-topics/talent-acquisition/Pages/DOL-Increases-H1B-Wage-Minimums.aspx">the rule was struck down</a> by a federal judge before it came into effect. </p>
<p id="sqkaX2">This past March, Sens. Chuck Grassley (R-IA) and Dick Durbin (D-IL) <a href="https://www.grassley.senate.gov/news/news-releases/grassley-durbin-introduce-bipartisan-h-1b-l-1-visa-reform-legislation">introduced a bill</a> intended to make the offshore outsourcing model less profitable, but it does so mainly via restrictions. For example, companies with more than 50 employees would be banned from hiring additional H-1B employees if more than half of their existing staff were foreign guest workers. This is intended to mostly affect offshore outsourcing firms, but according to some <a href="https://economics.nd.edu/assets/361162/bglennon_immigration_offshoring.pdf">previous economic research</a>, adding restrictions on guest visas often results in US-based companies outsourcing jobs rather than hiring more Americans, meaning it won’t have the effect the bill’s authors may have intended.</p>
<p id="YrOEZF">The <a href="https://www.congress.gov/bill/117th-congress/house-bill/3648/">EAGLE Act,</a> which contains a similar clause restricting H-1B employees to no more than half of a firm’s workforce, would also remove the per-country cap on employment-based permanent residency applications, helping address the decades-long backlog for Indian foreign workers, and benefiting citizens of other countries such as China, where interest exceeds the annual cap. It may be a hopeful sign that the predecessor to this bill, the <a href="https://www.govtrack.us/congress/votes/116-2019/h437">Fairness for High-Skilled Immigrants Act</a>, was <a href="https://bipartisanpolicy.org/blog/modernizing-immigration-eagle-act/">passed unanimously</a> in the Senate in 2020. </p>
<p id="BF16G3">Another bill, the <a href="https://www.congress.gov/bill/115th-congress/house-bill/2717">STAPLE Act</a>, which was <a href="https://www.indianeagle.com/travelbeats/stopping-trained-in-america-phds-from-leaving-the-economy-act/">proposed in 2017</a>, would prioritize issuing work visas and permanent residency to foreign graduates of PhD programs at US universities. This is similar to programs in <a href="https://www.canadianimmigration.com/study-in-canada/permnanent-resident-status/#:~:text=From%20Canada%20Study%20Permit%20To,program%20under%20which%20they%20apply.">Canada</a> and <a href="https://www.gov.uk/government/publications/the-graduate-route-information-for-international-students">the UK</a> that aim to attract international students to graduate programs, and then incentivize them to stay in the country permanently. Up to <a href="https://www.fwd.us/news/us-international-students/">100,000 international students per year</a> who graduate from US colleges and universities would stay in the US if they could. </p>
<p id="YzR6uF">Ideas floated in the economics literature <a href="http://qcpages.qc.cuny.edu/~fortega/research/h1b_coping2022.pdf">are varied</a>, but often focus on making the annual cap more flexible and responsive to current economic conditions, perhaps by taking into account the labor market demand in specific occupations. But while a more rigorous evaluation of all petitions would help allocate slots to the most critical workers, the scale of such a program might be intractably costly. Other proposals involve <a href="https://www.thecgo.org/research/an-auctions-approach-to-immigration-policy/">auctioning visa slots</a> to private-sector employers, or a <a href="https://www.canada.ca/en/immigration-refugees-citizenship/services/immigrate-canada/express-entry/eligibility/criteria-comprehensive-ranking-system/grid.html">points-based system</a> similar to that used in Canada.</p>
<p id="kZXOYJ">There’s certainly no shortage of solutions. The big challenge is the politics around the issue. There are data points that suggest a promising environment for reform: The foreign-born resident population in the US is at an <a href="https://www.the-american-dream.com/green-card-statistics/#:~:text=About%20one%20million%20people%20receive,Cards%20are%20issued%20every%20year.">all-time high</a>, with around 1 million new green cards granted each year (most family-sponsored rather than employer-sponsored). According to <a href="https://news.gallup.com/poll/1660/immigration.aspx">Gallup poll</a> data from 2021, the number of people in favor of increasing immigration has exceeded those who want to decrease it for the first time since Gallup began tracking attitudes toward immigration in the 1960s. </p>
<p id="nRQ0qz">But there’s no denying that the current political environment around immigration is highly polarized in the wake of the Trump administration. Earlier efforts to pass comprehensive immigration reform have crashed on the shoals of political reality. If the US slips into an economic downturn, the politics of making it easier for foreign workers to come to the country will likely become even more challenging. </p>
<p id="zMLXJh">Can an incremental approach work? Neufeld believes that changes to the H-1B system will be more likely to pass in isolation. The Biden administration has already <a href="https://www.pewresearch.org/fact-tank/2022/01/11/key-facts-about-u-s-immigration-policies-and-bidens-proposed-changes/">proposed a number of plans</a> to reverse the changes made during the Trump administration to restrict immigration. But the harms of such policies on American workers — both real and perceived — mean that the politics of immigration will continue to be tricky. </p>
<p id="9hbGbk">In other words, the odds for reform remain slim, which poses a challenge for any efforts to turbocharge the US’s innovation agenda. </p>
<p id="ghw2ru"></p>
https://www.vox.com/future-perfect/23177446/immigrants-tech-companies-united-states-innovation-h1b-visas-immigrationMiranda Dixon-Luinenburg