How to change global policy

How to change global policy

You and hundreds of millions of people have probably seen this graphic I composed as part of a long research document.

How do you convince the mayor of Medellín, Colombia to require masks on public transportation? Also the Philippines and Tunisia?

How do you get the US Surgeon General, the CDC to reverse their guidance on mask-wearing?

He even doubled down as late as March 28:

Here I’ll tell the story of how a large grassroots group behind #masks4all helped change global policy and saved thousands of lives in America. And probably the person who did the most is medical research scientist Jeremy Howard, along with #masks4all cofounder Petr Ludwig.

It all started on March 14, when Petr uploaded a YouTube video in Slovak explaining the importance of masks and why Czechs and Slovaks should wear them. (Coincidentally, March 14 is also the day my Slovakian friend who was living in Hong Kong first told me about all of the things Hong Kong was doing to beat the virus, including universal masks.)

Very quickly, this close-knit group of scrappy Eastern Europeans got to 100% compliance in just 10 days, and wrote a great history of it. Petr convinced Czechia and Slovakia (formerly the same country) to wear masks all through grassroots efforts, which then convinced politicians to wear and require masks in public. These became the first non-Asian countries to require masks, setting the example.

Independently, on March 17, professor Zeynep Tufekci published a detailed NYTimes Op-Ed explaining the utility of masks and why the governing authorities in the West should learn from Hong Kong and other Asian countries. This article was read by millions and convinced many, including myself, that this was a realistic option.

Even in our connected world, it can be difficult to learn about how these Asian countries do things, so I wanted to bring these ideas to the West. After I researched this more, I interviewed my friend in Hong Kong and wrote up a long research document and created a Facebook group. This community group collected hundreds of passionate members to amplify this information and get feedback on new ideas. Coincidentally, one member’s father is an epidemiologist, so in the group we promoted his excellent Mask Builders project and video. One graphic posted and iterated on in the group is this chart based on John Burn-Murdoch’s:

The graphic resonated with so many members of this community that it felt important to share this with more people and people who may know public policy decision-makers. So, I spent some money advertising it on Twitter asking people to ask the CDC to change its guidance. These tweets alone reached millions of views.

A professor wrote a data science lesson featuring the chart. This random Instagram influencer did an unscientific poll, and found that 25% of her followers had seen the graphic, a sample indicating that tens or hundreds of millions of people have seen it.

The graphic succinctly summarizes a key question: certain Asian country governments all recommend testing and quarantine, and Western country governments were following suit. However, scientists at their centers for disease control also recommend masks, and yet no Western countries were recommending masks. Why not? The information about why it does work is in the research document.

Some IYIs miss the point of the graphic entirely and would comment saying the graphic is not “statistical evidence” or “proof” that masks work, and that “correlation does not imply causation”. Of course not — Jeremy Howard points out that the public are already “aware that visualizations are a supporting communication tool, not primary evidence.”

On March 25, Jeremy Howard uploaded an amazingly deep video about masks with dozens of linked research articles. He started the website, and popularized the hashtag #masks4all. His reach is over 100,000 Twitter followers, and he also wrote a pivotal op-ed in the Washington Post. He contacted and educated the teams of politicians and CDC officials. This clearly turned the tide at the highest levels of government within a few days.

A number of online intellectuals and VCs with large followings including Zeynep Tufecki, Luca Dellanna, Balaji Srinivasan, Scott Adams, Naval Ravikant, Eric Weinstein, David Sacks, and Bobby Goodlatte and many others have been amplifying these messages from Zeynep and grassroots efforts for weeks.

All along, former FDA Commissioner Scott Gottlieb had been pushing for masks as well as other measures to slow the spread of the virus. The grassroots effort and more widespread understanding of masks’ efficacy helped add fuel to his policy recommendations which he could give directly to policymakers.

And finally, in April, just a few weeks after this all started, the Surgeon General and the CDC finally changed their stance and recommended homemade masks to the public.

It has even become a distinguishing issue for the most powerful position in the world: US President.

I learned many lessons about how ordinary people with a passion can create grassroots change. At a national policy level, a test case in a small country which can more easily be changed due to being a tight community (Liechtenstein often is a test country for new laws) can set an example. Hashtags are valuable since they work cross-platform and communicate a simple message and build a leaderless movement. Data visualization can convey a complicated idea very quickly and cross-language globally if done well. A Facebook Group allows you to build a community of people excited to get a message across, and it can provide valuable advice, feedback, and motivation. Op-eds in major newspapers help amplify a message to intellectuals, journalists, and other influencers. Getting key influencers who have followings or who have previous political connections help get the message to the right decision-makers.

I can only speculate as to why the CDC and WHO were not recommending masks, as Taiwan’s very successful government response always has and which Taiwan recommended to the WHO. One speculation is that they wanted to tell a noble lie, to avoid N95 mask hoarding. The latest claim is that there is “new evidence” that spread is asymptomatic, except that the world has known this since January, so this obviously cannot be true. Another lie, but now not so noble.

When I started pushing masks people told me racist things like “Asians follow orders,” “Asians are more community oriented,” and “Americans would never do it” — a bunch of baloney.

Wearing a mask is just the obvious, courteous thing to do when you have or could have a respiratory infection. Some Asian people only started wearing masks after the SARS-1 infections in 2003, and the West will start doing it now as of April 2020 due to COVID and common sense (California went from about 2% mask wearing to 80% in the last few days — after “following orders” from the CDC). You can buy a mask here.

It’s also pretty clear that many Westerners will voluntarily shelter in place (and now clear that they will wear masks) in order to protect loved ones and the community at large (except Sweden). This makes me rethink a lot these stereotypes of the West being more individualist and Asian people being more community oriented.

Maybe we are much more alike than people think.



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