PM2.5 Doesn't Have a Vaccine, and that is a Problem

Air pollution has a funding problem. We know it's harmful and takes over 8 million lives each year, which is higher than the death toll of HIV, malaria and tuberculosis combined. Yet, the funding for improving air quality remains limited, despite there being enough philanthropic funding to invest into this issue.

So what is the funding problem? In my opinion, this is related to how air pollution and clean air interventions are evaluated by funders. In our field, it is difficult to tell a funder with confidence: “The USD 1m you gave, saved 10.000 people’s lives.” For some areas of global health, that link is much clearer.

A vaccine is given to a specific person, against a specific disease, with decades of evidence connecting the intervention to the outcome. We don't need to prove that every individual vaccination prevented a death.

So basically there is a direct link between getting the vaccine shot and lives saved.

Unfortunately that’s not the case with air pollution. The positive effects of cleaner air is a much more complex and lengthier process. You might distribute face masks, improve building ventilation, install air filters, reduce burning practices, change industrial emission policies, or build a monitoring network that helps a community understand and protect themselves from what they are breathing.

These cause and effect relationships are much more difficult to establish. However, this doesn't mean the impact is smaller. It only means the impact is harder to measure.

So what we are looking at is not an impact problem, we have a measurement and attribution problem.

Evidence-based philanthropy is a good thing.

We should measure what we can, challenge our assumptions and stop funding things that don't work. But we should not confuse what is easy to measure with what is important. Unfortunately, this uncertainty, I believe, makes clean-air projects less attractive to fund.

GiveWell explicitly models interventions such as insecticide-treated malaria nets and preventive malaria medication in terms of expected lives saved and cost-effectiveness; it recommended a $41 million grant for mosquito nets in the DRC partly because it estimated the program to be around 11 times as cost-effective as unconditional cash transfers. The Gates Foundation has similarly committed enormous sums to vaccines and infectious-disease prevention, including $1.6 billion to Gavi over five years, where established evidence allows vaccination coverage to be translated into expected disease and mortality reductions.

These are extremely valuable investments, but they illustrate the challenge for clean air. A decision maker at a large philanthropic organisation will most likely put the money where the cause and effect relationships are well proven and that puts clean air investments at a disadvantage - not because the impact is necessarily lower but simply because the causal chain is longer and harder to measure.

Sometimes, I really wish, there would be a vaccine for PM2.5. Just give large parts of the population a shot and they would live a few years longer without the burden of air quality causing diseases. Unfortunately that’s not possible.

But part of the problem is that there has not only been little investment directly into air quality improvement projects but likely even less investment into building the infrastructure that would allow us to actually make the causal link between pollution levels and health burdens much more obvious. Vaccines are not just randomly finding it’s way into people’s bodies, it actually builds on very sophisticated infrastructure build over many decades to ensure that the right vaccines reach the right places and the right people, and that the effects of the vaccines are thoroughly observed and measured in extremely high detail.

So basically we talk about a massive logistical, communication and measurement infrastructure that form the base of the success for vaccines. How did that happen? Through investments into infrastructure.

This is what we need to do much more for air pollution. And this problem has shaped how we think about the Open Air Foundation and why we focus on open public infrastructure.

At the core of the Open Air Foundation is to build open public infrastructure for airborne environmental health and address directly the areas mentioned above. Providing open monitoring tools, open-source hardware and software, combined with local capacity building that makes air quality measurements much more affordable and commonplace and linking that data to improved health outcomes and quality of life.

And the first projects are already on the way. With UNICEF in Lao PDR we covered the whole country with 148 air quality sensors, one in each province. But we did not stop there, we built an interface with DHIS2, an open source health information system used by the public health sector in Lao. Now it’s possible to see the direct effect from high air pollution episodes with hospital admission rates and the occurrence of respiratory diseases.

This is just one example, how targeted investments into creating infrastructure to build the causal relationship between air pollution and health can happen.

So, Does PM2.5 Need a Vaccine?

I still wish there were a vaccine for PM2.5. But the lesson from vaccines is that their success depends on much more than the shot itself. It depends on decades of investment in the infrastructure that delivers it, measures its effects and helps programmes improve.

Clean air deserves that same long-term commitment. We need to fund interventions alongside the monitoring networks, local expertise and connections to health systems that allow us to understand their impact. Building this infrastructure is part of protecting people’s health, and it should be funded as such.

We cannot keep asking clean-air projects to prove their impact while underfunding the infrastructure needed to measure it.