In the early weeks of the Covid pandemic, in those days when public spaces emptied and hospitals filled up, I used to see this magazine cover from 2017 being passed around social media. The story was a familiar one to me, because I was the one who had written it:

The posts were all versions of the same thing: The warning signs had been there, we knew something like this was coming, why weren’t we prepared? All of which was true, and all of which I had been trying to get across in that story, which was itself the culmination of years of reporting on emerging diseases: SARS in Hong Kong in 2003, H5N1 bird flu in Indonesia in 2007, H1N1 flu in 2009. Surely I’d seen Covid coming too.

Except I hadn’t. Through January and into February 2020, as lockdowns and cases of what would soon be called Covid-19 accumulated in China and then elsewhere, I remained surprisingly nonchalant. I assume it would burn out, much like bird flu itself or MERS or Ebola or any number of scary viruses that didn’t quite have the legs to cause global catastrophes. If you’d asked me for predictions, I probably would have said a (hopefully) more sophisticated version of what President Donald Trump said on February 25, a day before the first suspected community transmission in the United States: Covid was “going to go away.”

I was wrong, obviously. I couldn’t make myself see it — or maybe, I couldn’t make myself believe it, believe that we were about to experience sudden, transformative change. And I wasn’t alone. On February 19, 2020, just before Italy reported its first cluster of Covid cases, the S&P Index hit an all-time high, which is not the behavior of markets anticipating what actually happened next: an unprecedented global economic shutdown.

I now believe a similar economic blindness is at work today, with a different crisis.

The crisis we’re not pricing in

That crisis is the war with Iran, and specifically the ongoing closure of the Strait of Hormuz. The numbers are not subtle. The International Energy Agency calls it the largest disruption in the history of global oil markets, with global supply down by more than 10 million barrels a day in March. The Atlantic Council notes that the 1973 oil embargo — the shock that defined a decade of American economic anxiety — pulled 7 percent of global supply off the market. Hormuz has cut that same supply by 13 percent, and the infrastructure damage from the war and the shutdown will take months or years to repair.

The downstream effects are everywhere if you look. In Como, Mississippi, a 73-year-old corn farmer told NPR he is buying diesel “hand to mouth”; fertilizer is up 60 percent, an increase so steep that he may not fertilize his corn this spring at all. In Dhaka, vehicles are lining up around blocks for propane refills. The Philippines declared a state of national energy emergency. South Korea, Thailand, and Vietnam are rationing fuel. Lufthansa has already canceled 20,000 summer flights.

And yet in the same week the New York Times put all of this on its front page, the S&P 500 hit another new all-time high. The disconnect is dizzying. As one analyst quoted by David Dayen in the American Prospect put it, “The market priced peace. The oil system didn’t.” 

How we miss what’s in front of us

So why the gap? Why are markets, and many of us, treating the largest energy disruption in history as just another potentially bad thing that probably won’t actually happen?

The answer, I think, speaks to the same factors that kept me from believing a pandemic was coming in February 2020. Human beings are systematically bad at recognizing the moment when a slow-moving or theoretical threat becomes a clear and present one.

Wharton economists Robert Meyer and Howard Kunreuther call this the ostrich paradox, and they identify six biases that drive it: myopia, amnesia, optimism, inertia, simplification, and herding. Investors are betting on near-term political resolution (myopia), drawing on the pattern that Trump has often reversed market-damaging policies like tariffs (amnesia and optimism), defaulting to buy-the-dip behavior (inertia and herding), and tracking earnings while ignoring the effects of physical supply chain disruptions (simplification). 

The deeper problem is that human cognition is built for sudden threats with a specific source — the punch you can see coming — and badly miscalibrated for diffuse, distributed ones. Harvard psychologist Daniel Gilbert has argued that gradual threats fail to trip the brain’s alarm, leaving us “soundly asleep in a burning bed.” A 2025 paper in Science by UCLA’s Rachit Dubey and colleagues showed this formally: When information arrives in continuous form — fertilizer up 60 percent in Mississippi, propane queues in Dhaka, another flight canceled in Frankfurt — people fail to perceive a shift even when the shift is real. A binary headline (“the strait closed”) would register more sharply. But the closure of Hormuz, like the early spread of Covid, hasn’t been a headline. It’s been a process.

Gradually, then suddenly

But you can only ignore reality for so long, and when transformative events happen, change comes fast.

Five weeks after the market hit that all-time high on February 19, 2020, it was down 34 percent — the fastest correction from a peak in market history, as Covid was finally priced in. The information that produced the crash had mostly been available weeks earlier. What changed was not the data but the integration of the data: the moment when the abstract became concrete, when Wuhan and then Italy and then Seattle made what had been a story about Over There into a story about Right Here. Markets didn’t suddenly become smart. They just became unable to stay dumb.

While I can’t see the Iran crisis causing anywhere near the economic disruption of Covid, I do think we are weeks from a similar shift. In the spirit of Future Perfect forecasting, I’ll express that thinking as a falsifiable prediction: If the Strait of Hormuz remains materially restricted through June, the S&P 500 will be at least 10 percent off its April 22 high by Labor Day. 

You shouldn’t take financial advice from me, but I’m no more alone in my pessimism today than I was in my careless optimism as the pandemic was spreading. Princeton Policy Advisors has forecast a US recession beginning in May; the IMF, which projected 3.3 percent global growth in January, has now cut its baseline to 3.1 percent and added an adverse scenario at 2.5 — the latter approaching territory the world hasn’t seen outside the 2008 crisis and the pandemic. Mark Dowding, the chief investment officer at RBC BlueBay, told Bloomberg last week that the current market reminds him of February 2020: “Only when it truly disrupted our lives did the market see bigger shocks.” 

I missed the Covid pandemic, even with a magazine cover predicting it sitting on my desk. The market missed it too, right up to the day it didn’t. I hope we don’t miss the next big disruption. There is still time, but probably not much.

A version of this story originally appeared in the Future Perfect newsletter. Sign up here!

A surprising quirk of the Trump administration is that every so often, it tries so hard to be anti-woke that it accidentally does something woke. 

See, for example, the efforts of Secretary of State Marco Rubio, who oversaw USAID’s demise — directives that have contributed to the deaths of hundreds of thousands of people — and who stood at the White House beside the president of Kenya a few months ago, railing against what he called the “NGO industrial complex.”

Now, I don’t know who taught Rubio that progressive catchphrase, but I doubt that he got it from INCITE!, the radical feminist collective that popularized a variation of the term in an anthology that examined the role of nonprofits in undermining social progress. In the two decades that followed, the idea of a nonprofit or — as they’re often known in international contexts — NGO “industrial complex” grew into a snarky self-critique for much of that sector’s left-leaning young workforce. By the time Teen Vogue used the term in 2022, the phrase also hinted at an enduring related criticism of USAID’s tendency to primarily fund Western nonprofits rather than local governments and organizations in recipient countries. 

In an unexpected twist, this term has found its way into the vocabulary of a very Republican secretary of state, now reflecting a preference for funding foreign governments over non-governmental organizations (NGOs). “If we’re trying to help countries, help the country,” Rubio said in his remarks in December announcing a new $1.6 billion bilateral aid deal between the US State Department and Kenya. “Don’t help the NGO to go in and find a new line of business.”

Whatever one thinks of Rubio, he has a point. As part of the “America First Global Health Strategy” announced last year, the Trump administration has embraced an approach to foreign aid that more left-leaning reformists have been talking about for years, a concept known as localization, or the idea that giving aid directly to local governments and organizations — not Western nonprofits — is the best and most cost-effective way to strengthen global aid overall and global health systems especially. In recent months, the US has negotiated dozens of deals between the State Department and African governments, which are set to collectively receive billions of dollars that they can spend as they see fit. 

The logic might seem sound. But it hasn’t happened sooner because it’s also risky. It’s harder to audit a foreign government than a well-established, well-connected NGO. And millions of lives are on the line. The transition from the one approach to the other is also fraught: Dismantling USAID has disrupted access to vital medications and health services around the world, leading to mass suffering and loss of life. It is unclear if this new strategy will be able to fill those lapses in care, especially for the women and children most vulnerable to aid cuts.

But if there were ever a moment to blow up the entire old aid order, it’s arguably now, when there is very little left to lose. And it turns out some surprising figures in global health are cautiously optimistic about it. 

“They’re basically making a bet that they can do it and get away with it, and if things go wrong, they’ll get a bit of a pass,” Rachel Bonnifield, director of the global health policy program at the Center for Global Development, said of the administration. “And that’s probably true, and it very well might be a good thing” for global health in the long run.

It comes at a critical juncture for global health and American foreign aid more broadly. “We all have to work hard to ensure that these disruptive moments are moments of real progress,” said Jirair Ratevosian, a senior adviser for health equity policy under the Biden administration and now a senior scholar at the Duke Global Health Institute. If all goes well, the strategy could “be a huge success for this administration,” he said, “something that I think, decades from now, public health will credit this administration for.” 

It’s worth noting, however, that this MAGA-fied global health strategy has also doubled as just another way for this administration to get other countries to do what they want. For example, watchdog groups have raised serious concerns about the terms of the new deals, which require African countries to share sensitive health data and even precious minerals with the United States just to keep their clinics open. Many people won’t get their HIV meds at all this year simply because Trump takes issue with the governments they live under. And the administration’s rushed timeline — which included shutting off existing aid flows overnight, instead of transitioning over time — has led to deadly lapses in services in the countries that can least afford it. 

What’s clear is that this administration has enacted the most sweeping reform to global health in a generation. But so far, they’ve opted to do so in the worst way possible. The question for those that inherit this new structure is whether something good can come from it: Will this change herald a new norm of more effective giving that advocates have dreamed about for decades — or will global aid fully transform into another cudgel that this White House and the next ones brandish to pressure poorer nations into doing their bidding? 

The USAID system was imperfect — even if its work was crucial

Margaret Odera is a community health worker in Kenya. In 2006, she was diagnosed with HIV and nearly died of the virus before a local health worker, funded by USAID, convinced her to seek free anti-retroviral therapies through PEPFAR. 

“My life was saved through USAID,” Odera, who also credits the agency with helping her find her own calling as a health worker, told me. Despite that, she often felt that there was something amiss about how it distributed its resources.

“Most of the money, maybe 70 percent of it, was going directly into people’s pockets,” she said with a sigh, instead of “coming to the ground for community members.” She’s referring here to the notion that foreign (often North American or European) nonprofits gobbled up most of USAID’s budget, while local health workers on the ground like herself received minimal support. 

It is true that almost all of the big USAID contracts went to a small group of large organizations, many of them American NGOs. As of 2024, just over 10 percent of USAID grants and contracts went to local groups in recipient countries, a statistic that Elon Musk later called out to smear the agency as fundamentally wasteful.  

Despite the Trump administration’s admonitions, there is no evidence of widespread waste, fraud, or abuse at organizations funded by USAID. In fact, their work saved millions of lives each year. 

Still, the US might have been able to save even more lives if local groups and governments played a more central role in distributing aid. The research group the Share Trust found that channeling funding through local groups is 32 percent more cost-effective than funding higher-salaried Western NGOs.

“I don’t think it’s as inefficient as they say it is, but it’s undeniable that there is overhead incurred in the United States,” Bonnifield said. Between the higher prices of foreign salaries and the expense of transporting workers to and from the countries in which they’re working, the costs simply “add up and get expensive.” 

And that means less money for Odera and other local health workers, who in Kenya, are paid a meager government stipend worth about $35 per month — less than the country’s minimum wage. There are roughly 3 million community health workers globally — who often serve as a critical, and sometimes only, line of medical contact, especially for people in poorer countries. And the vast majority of these workers do not receive any salary at all. 

Before Trump, USAID-funded NGOs did employ and pay a massive number of local health workers. But this model also led to a kind of parallel health care system, Bonnifield said, where NGOs — with their big budgets and better salaries — would inadvertently “poach from the public sector.” 

The result was a bifurcated health sector. While USAID was very effective at combatting specific diseases like HIV or malaria, these programs were effectively siloed from countries’ broader primary health care systems, which often went underfunded. Many people knew where to get their HIV meds, but struggled to find a primary care doctor.

“People want to go to a health care center, and they want to get all of their support in one stop,” Ratevosian said. “They want to get tested for HIV, they want to pick up their malaria medications, they want to get checked for high blood pressure, just like anyone else wants to in any other country in the world.”

The art of the global health deal

But even though USAID was never perfect, its wholesale destruction instantly put millions of people’s lives at risk, thrusting local health workers into a panic around the world.

Odera remembers the chaotic day the agency laid off its health staff — including a clinic providing HIV care and anti-retroviral therapies — in Mathare, one of Kenya’s largest slums. 

“I feared for my life,” said Odera, who still relied on USAID to keep her own HIV in check. “I was asking myself, ‘What will happen five years from now, if I’m not taking drugs? I still have small kids, who I’m educating, and if I die now, what will happen to my children?’”

Hundreds of thousands of people around the world did die in the immediate aftermath, from hunger or preventable diseases, unable to access previously USAID-funded resources. 

In the following months, however, elements of USAID’s work experienced a groggy rebirth, culminating in September with the release of a new “America First” global health plan, parts of which read oddly familiar to progressive reformists who favor localization. 

Suddenly, it seemed, the Trump administration was ready to make a deal: As part of an untested new strategy, the US would enter into “multiyear bilateral agreements” directly with recipient countries, offering up to billions of dollars of support in exchange for the promise to progressively increase their own domestic health spending to varying degrees. Kenya’s was the first to be negotiated in December, followed by Uganda, Sierra Leone, Ethiopia, and others soon after. As of March, the US had negotiated bilateral deals with 27 countries across Africa and Central America.

At first glance, “of course we were excited,” said Peter Waiswa, a Ugandan health systems researcher and associate professor at the Makerere University School of Public Health. Not only was US global health aid on the rise but for the first time, local authorities would take center stage. 

“From a systems perspective, there’s no alternative to government in terms of doing a public good,” Waiswa said. “And so that was exciting that maybe at last, the [Ugandan] government will have a little bit more to be able to deliver.”

But this is the Trump White House’s global health strategy after all, and the State Department has made no secret of advancing its own interests in shaping bilateral deals.

For one thing, the White House expects recipient countries to share health data and biological specimens with the US government. This is ostensibly put forth as a means of quickly identifying and quashing disease outbreaks as they arise, which might sound like a benign addendum — it is generally good when countries share health data with one another. But advocates have raised alarms over whether the data-sharing terms will abide by local privacy laws, and, moreover, whether African nations will actually benefit from any health innovations gleaned from the data, such as when African countries struggled to access Ebola treatments developed from their own citizens’ health data.

Allan Maleche, executive director of the Kenya Legal & Ethical Issues Network on HIV and AIDS, said that the biggest concern is about who controls that data, and eventually profits off of it: “What are the consent and limitations safeguards when you share data across borders?”

In December, dozens of organizations signed a letter addressed to African heads of state raising objections to the data sharing requirement. Kenya’s health deal with the US is currently on hold until a data privacy lawsuit proceeds through that country’s court system. And Zimbabwe ended talks with the US about health aid in February over similar concerns. 

Another emerging risk is that the agreements could come with increasingly strict geopolitical strings attached. In Zambia, the US State Department has refused to sign over lifesaving aid unless the country agrees to fork over its vast mineral reserves to American businesses. 

“It is effectively not really a health strategy, but a security and economic strategy,” Mihir Mankad, director of advocacy and global health policy at Doctors Without Borders, told me. Other countries on the president’s bad side, such as South Africa, have been excluded from the negotiations altogether, severely disrupting their responses to public health crises.

“They pick winners and losers every single day,” Ratevosian said. “They punish people who don’t subscribe to their beliefs, and that is carried over to foreign assistance — and that’s a recipe for danger.”

The risky, radical future of foreign aid

Odera, the community health worker, is choosing to not care about those concerns right now, because for the first time in a long time, she feels optimistic. She’s frustrated that Kenya’s agreement with the US has gotten caught up in the courts. 

“Anything that improves the health security of our country is good for me,” Odera said, who is convinced that soon enough, with money going into the Kenyan government’s hands, the benefits will trickle down to local health workers like herself. All she’s asking for is a minimum wage, which in Kenya, is about $120 per month.

It will take months, maybe years, to see if that materializes. And as hopeful as Odera is, even she worries there’s a risk that, without proper oversight, the money could easily be lost to mismanagement. For what it’s worth, studies on the effects of bilateral aid on corruption have had mixed results, with some researchers finding little association between the two, and others finding a significant risk, especially when aid doesn’t come with anti-corruption requirements. Under the previous USAID model, despite the Trump administration’s claims, evidence shows that corruption was rare. Well-resourced NGOs tend to have established systems for keeping their accounting in order, for example, even in very fragile contexts like Afghanistan, where audits by USAID found that only about 0.4 percent of funds ever strayed from their intended purposes. The Trump administration fired the USAID watchdog charged with monitoring corruption back in February of last year. 

And every global health expert I spoke with for this story agreed that in the long run, moving more money into local hands is a good thing. US presidents have been trying and mostly failing to do so for years. But nobody has ever dared to do it so quickly — and for good reason. 

Yes, the NGO industrial complex was flawed. But it also played a crucial role in making HIV a much less deadly disease around the world and helped make it the safest time in history to be a child. It often found ways to protect those who face discrimination or live on the margins, including women and LGBTQ people, even when their governments chose not to. And we very well may miss it when it’s gone. 

“If there is an advantage to the abruptness [of the Trump administration’s changes], it’s that people have to take it seriously immediately,” said Mankad of Doctors Without Borders. “But if there’s a disadvantage, it’s that the bottom could fall out right away.”

In a perfect world, there would be no need for NGOs. There would be no need for foreign aid. Odera and other local health workers like her would earn the salaries they deserve without having to rely on often capricious aid flowing from the powers that be in Washington, DC.   

But we don’t live in that world. And so far, it’s entirely unclear whether the Trump administration’s blustery, bullying approach will even come close to ushering in the vision of a world without a need for foreign aid, one in which people like Odera can thrive. But for many people in the poorest nations, the road ahead could be deadly — or at least very rough. For many of these countries, the co-investment that Trump’s deals require may be far too expensive to sustain, and the logistics too complicated to organize overnight.

Even so, this structural shift is probably permanent. Future US administrations may eventually bring more NGOs back into the fold to backstop local governments and help ensure the continuation of care for those who need it — but the era of largely bypassing recipient governments is rightfully, incontrovertibly coming to an end. 

“It aligns with where the momentum is elsewhere in global health, and what the demands of African countries have been for some time,” Bonnifield said. “It will be hard to come back from this.”

Butter chicken has disappeared from some restaurant menus in India. Sri Lanka declared every Wednesday a public holiday. Laos cut its school week to three days. Egypt ordered shops and cafes to close by 9 pm. In Thailand, government workers were told to take the stairs instead of the elevator. And in South Korea, the president urged citizens to take shorter showers.

These are wartime policies, even though none of these countries are actually fighting a war. All of them, however, are caught in the blast radius of one being fought thousands of miles away. That’s because the closure of the Strait of Hormuz, triggered by the US-Israeli strikes on Iran that began on February 28, has detonated a crisis that reaches into kitchens, classrooms, hospitals, and fields across the Global South.

Twenty-one miles wide at its narrowest point, before the war, the Strait carried 20 percent of global oil, 20 percent of liquefied natural gas (LNG), a third of seaborne fertilizer, and nearly half of the world’s sulfur exports. Commodity shipments have fallen by 95 percent. The Strait is, in effect, closed, and the consequences are cascading through the lives of an estimated 3.2 billion people in countries now subject to some form of fuel rationing, power cuts, or energy restrictions.

The food crisis

Start with food. India imports the majority of its cooking gas through the Strait, and the disruption hit almost immediately. Black-market prices for a single liquified petroleum gas (LPG) cylinder — the kind that powers a family kitchen there — have nearly tripled. Restaurants across the country have slashed their menus; a 70-year-old Mumbai institution trimmed its elaborate multicourse Ramadan offerings to just four dishes. A chain in the same city stopped selling dosa entirely, because the dish requires an open gas flame. A handwritten sign at a Bengaluru restaurant went viral: “There will be no roti due to gas cylinder crisis (due to war between Iran and USA).” Nearly 10,000 restaurants in the state of Tamil Nadu alone face closure.

The fertilizer crisis hasn’t yet had the same level of immediate effects, but the longer-term impact looks grim. The Gulf produces roughly a third of the world’s exports of urea, a key ingredient in fertilizer, and the closure hit at the single worst moment in the agricultural calendar — just as Northern Hemisphere farmers need to apply fertilizer for spring planting. 

Bangladesh has shut down four of its five state-owned urea plants. Nepal, which produces zero chemical fertilizer domestically, has seen urea prices jump 40 percent ahead of its critical paddy season. In Brazil, sugar mills are diverting their new harvest toward ethanol — which is more profitable, with oil above $100 a barrel — which could tighten global sugar supplies for months. 

The World Food Programme warns that 45 million more people globally could be pushed into acute food insecurity — an increase of 15 percent on current hunger levels. As if that’s not enough, the closure of the strait has stranded vital United Nations food aid in warehouses in Dubai, crippling the ability of relief agencies to get supplies where they’re needed most. 

A scary climate

Then there’s the environmental fallout, which may be the single most consequential long-term effect of the crisis. 

The disruption of relatively clean LNG supplies has triggered a coal resurgence across Asia and beyond. Japan is planning to lift rules that required its oldest, dirtiest coal plants to run at less than 50 percent capacity, which means more carbon dioxide and other pollution spewed into the air. South Korea removed its own seasonal cap on coal power and delayed the retirement of three coal plants. Thailand, the Philippines, and Indonesia are all expanding coal operations. And in Europe, Germany is reviewing whether to restart mothballed coal plants. 

Coal companies — whose product is the single-biggest contributor to climate change — are reaping the benefit. Australia’s Yancoal is up 40 percent since the war began, while Pennsylvania-based Core Natural Resources is up 30 percent. And once turned on, coal plants can be politically difficult to shut down again, which would risk a longer-term carbon lock-in. And it’s not just about climate change. In India, the government has formally permitted restaurants and hotels to burn wood, dried crops, and cow dung — undoing years of clean-fuel progress and putting more lives at risk in the process in a single directive.

If you squint, there could be an eventual silver lining to all of this. In Nepal, over 70 percent of new car sales are already electric. Electric rickshaws are selling out in Pakistan. The Chinese electric car maker BYD is now projecting overseas sales to be 15 percent higher than they were expected before the war. One energy analyst called this “Asia’s Ukraine moment” — a shock that could accelerate the shift to renewables the way Russia’s invasion pushed Europe toward wind and solar. 

Hastening the clean energy transition, however, won’t put food on the table for billions of people throughout the Global South, and more coal and other dirty fuels in the short term will endanger more lives around the globe. The world’s poor may not be fighting the Iran war, but they are surely suffering from it.

A version of this story originally appeared in the Future Perfect newsletter. Sign up here!