Summary

The mission of the Policy Entrepreneurship Network (policyentrepreneurs.org) is to accelerate innovation in important, yet neglected areas of public health policy. We’re doing this by partnering with local actors around the world working on what we’ve identified as some of the best opportunities in this space. Our aim is to deliver the additional shared capacity that otherwise wouldn’t be available to our partners, who typically are under-resourced.

The Network was launched in the fall of 2019 with a $50,000 incubation grant from Charity Entrepreneurship. Since then, we have:

• Investigated the history and the current shape of the debate around fiscal policies for health through literature review and expert interviews
• Investigated closely the case of tobacco taxes in Ukraine, where the death rate from smoking is among the highest in the world, while the prices of tobacco products are among the lowest
• Built a partnership with the Ukraine-based Advocacy Center LIFE, with whom we’ve launched the pilot campaign priceofsmoking.org (currently scaling up)
• While interrupted by the pandemic, we’ve launched @stayhomecampaign, a pilot of an online campaign aimed at promoting social distancing, good hand and respiratory hygiene between early March and July 2020; also to advocate for policy changes to ensure countries are better prepared to prevent, detect and respond to pandemic threats (after joining the Pandemic Action Network in May 2020)

This post serves as a shortened report from the initial year of our operation and a summary of our plans for the year to follow.

We also announce opportunities for donors and job seekers looking to drive our growth throughout the year 2021.

Chronology

• Sep 2019: The Policy Entrepreneurship Network is formed
• Sep 2019 to Oct 2019: Literature review, expert interviews
• Oct 2019 to Nov 2019: Site visit in Kyiv, Ukraine
• Nov 2019: One of the co-founders leaves
• Dec 2019: Strategic planning, literature review
• Jan 2020 to Feb 2020: Campaign development (priceofsmoking.org)
• Mar 2020 to Jun 2020: Campaign development (@stayhomecampaign)
• Jun 2020 to Aug 2020: Campaign development, strategic planning

Our work so far

Mapping the space of fiscal policy for health

The single most cost-effective way to save lives in developing countries is in the hands of developing countries themselves: raising tobacco taxes. In fact, raising tobacco taxes is better than cost-effective. It saves lives while increasing revenues and saving poor households money when their members quit smoking.

W. Savedoff and A. Alwang, The Single Best Health Policy in the World: Tobacco Taxes (CGDev 2015)

Following the recommendation by Charity Entrepreneurship, we invested the initial two months in getting a deeper understanding of the space of tobacco taxation and some connected key issues. We were privileged to interview several renowned international experts in the field as well as those they recommended we speak with to get a more complete picture. Our goals were to identify the global and regional priorities; map out the existing networks; see whether there were any gaps or opportunities for us to deliver value with our then-current knowledge and funding (or any sum we could realistically gather).

Our preliminary finding was that while there is a significant number of organizations working in the space of tobacco taxes, they’re typically underfunded and under-resourced. Having identified that as one of the key bottlenecks, we ventured forth to learn more from those who work on the ground in some of the countries we saw as most promising.

Site visit in Ukraine

We decided to visit Kyiv between late October and early November, soon after concluding the initial round of expert interviews and literature review. There, we discussed the situation with our future partner, the Advocacy Center LIFE.

In Ukraine, the death rate from smoking is among the highest in the world, while the prices of tobacco products are among the lowest. The country has already passed a law in 2018 to increase taxes by 20% annually until 2025. However, that development remains under threat from an opposing interest group.

Studying the history of tobacco taxes in Ukraine will reveal to you that soon after privatising the state-owned industry in 1993, the excise was reduced from the WHO-recommended level, which requires that at least 70% of its retail price is tax, to an amount that lowered that ratio to 10% (for unfiltered cigarettes)^[1]. That only took until 1995. Revenue considerations caused Ukraine to increase excise in 1999, but this again ended up in a decrease as soon as in 2001, motivated by the will to fight Russian smuggling (where the causal link is rather weak^[2][3]).

Ukraine increased excise 4 times between 2005 and 2008, the period during which the country has also ratified the WHO’s Framework Convention on Tobacco Control, which encourages price and tax measures as effective means to reduce the demand for tobacco. The policy resulted in only a modest price increase that didn’t even keep pace with inflation. Rising disposable income increased the affordability of cigarettes in Ukraine (as it currently does in many other countries across the globe), and so the sales increased by 17% in 2008. This was said to be a result of a successful lobbying effort^[4].

To present a complete historical outline is outside the scope of this report, but we mention these facts to point at a pattern that characterises this space more broadly. Getting (and keeping) tobacco taxes in line with WHO’s recommendations requires an indefinite, energetic effort of both local and international health organisations. It’s worth pointing out that in this debate, it’s the side that represents the health interests of a broader population that’s well under-resourced and up against a powerful foe. There clearly are instances where it succeeds despite this disparity, and one such success story is that of LIFE.

One of our key questions at this point was how to best contribute to similar efforts as third party newcomers. Our interviewees gave us a broad picture of the field along with some hints on what portions of it are too technical, or too politically sensitive for us to enter on our own. In general, they recommended that, instead of starting from scratch, we form coalitions with those who already work in the field. We used this input to build our theory of change around empowering local actors who already make progress, and would likely make more with additional resources.

LIFE, in particular, offered us the opportunity to join their campaign by bringing about an online data storytelling platform to illustrate their case. We gladly accepted since we’ve already had certain capacity in this space (my own background is in philosophy and cognitive science, movement building, software engineering and finance).

Before we started this work, but still in November, my co-founder communicated with us that he is off to look for opportunities elsewhere and on his own. As a result, the Network’s capacity was halved, and so was its budget.

There briefly existed 3, then 2 organisations to graduate from Charity Entrepreneurship’s 2019 cohort aiming to settle into the space of tobacco control. As far as we know, the Policy Entrepreneurship Network is the only one left to actively pursue this. We are currently growing to make up for that reduction (more details below).

The Price of Smoking Campaign

On the 8th of July 2020, LIFE held a press conference in Kyiv. It was dedicated to the effectiveness of the 7-year plan to increase taxes on cigarettes by 20% annually and harmonizing tax rates on heated tobacco products with taxes on cigarettes.

Among the invited speakers was Member of the Parliament Lada Bulakh who spoke about legislative initiatives to protect public health from the harmful effects of tobacco, in particular, the Law 66466-IX (Bill №1210), already signed by the President, which will reduce the affordability of electronic cigarettes, cigars, and heated tobacco products; and about the comprehensive tobacco control bill №2813, which bans the sale of electronic cigarettes and heated tobacco products to children. The conference was a success, receiving high media coverage (while the total circulation of the press release by the top news agency Ukrinform exceeded 60,000).

There was an element of that conference that wouldn’t appear if not for the Policy Entrepreneurship Network. It’s the website priceofsmoking.org that we’ve put together on request and in collaboration with our partners. It was presented live, with the purpose to illustrate LIFE’s health and economic case with the use of interactive data visualisation. We have received positive feedback and we’re currently producing a video version of it, with the intention for LIFE to circulate it further.

Depending on the performance of this campaign, we’re ready to replicate it outside of Ukraine. The website itself is open-source and open for contributions. We want it to serve as a template that other organisations can use without charge.

More generally, we hope to be able to scale the model of identifying outstanding local organizations and providing them with support (defined as staff time or other resources) at key junctures during which they may be particularly influential on innovating health policy in their respective areas.

@stayhomecampaign

At its peak in April, @stayhomecampaign had a monthly reach of over 1,000,000. It was achieved at a total cost not exceeding $500 [...]

Our work on the Price of Smoking campaign was interrupted by the outbreak of the COVID-19 pandemic. With the beginning of March 2020, after communicating with our partners in Kyiv, we decided to put the campaign on hold and switch our focus to work on this new global health crisis.

We've launched facebook.com/stayhomecampaign on March 13, and soon after, a version of the website stayhomecampaign.org. Their aim was to amplify the messages that promote social distancing, which at that time wasn’t a universally recognised approach to “flattening the curve” (which wasn’t yet a broadly used metaphor).

We started by growing our audience in Eastern Europe, where we learned based on interviews social distancing wasn’t widely practised as a solution to slowing the outbreak. We did have a broad existing network to get the campaign off the ground, and boosting our content wasn't expensive compared to other places (like London).

The campaign gained traction early, with its community forming mainly among the residents of Romania, then joined by those of Greece, Portugal and other countries in Europe. By the end of March, when the majority of European countries went into lockdown, the campaign went viral in West Bengal. This was a mostly spontaneous event and our decision was to not interfere. It did, however, change the pace and the context of @stayhomecampaign. From here, it didn’t take long for it to spread to the rest of India, Bangladesh and elsewhere in Southeast Asia, where the response was overwhelmingly enthusiastic.

In consultation with the locals, including health workers, and the official sources, we decided to

• repurpose stayhomecampaign.org from offering WHO’s guidelines in simple English and several other languages to aggregating links to local initiatives offering localised and contextualised advice (while still in adherence with WHO’s messaging).
• modify the key message towards “stay at home when you can, stay safe when outside” and broaden the repertoire to include messages promoting empathy, good hand and respiratory hygiene, protecting individuals aged 65 and over, manuals for making masks, and other messages recommended by the WHO.

Over time, we moved towards simpler, shorter messages, and, eventually, pictures. Our content was sourced through the team of artists, producers and social media consultants we gathered around this project, or from the broader resource pool created as an answer to the United Nations’ Global Call To Creatives (to which we responded). Some of the content was sourced from the community itself.

At its peak in April, @stayhomecampaign had a monthly reach of over 1,000,000. It was achieved at a total cost not exceeding $500, mainly in paid promotion, among those who “liked” our fan page (~12,000 people to date), of the content that was observed to gain organic interest when posted.

We reached out to a few other organisations offering to share our platform. With their feedback, it became clear that the farther we'll travel with our campaign, the more limitations it will encounter. Those limitations included the status of English as a language of communication, as in the case of Ethiopia, or the penetration of the Internet — as in the case of Malawi, where a group of local activists reached out to us with the request to promote our messages there.

In Malawi, the Internet penetration in 2017 was 14%. We estimated that with paid ads and our then-current performance, we will reach the estimated 500,000 Facebook users there within 5 days. The rest of the population of this country of 18.6M was to be reached by some other means, just as 46% of the world’s total population.

In response to that, we ran a quick feasibility study assisting the locals in preparing the launch of an SMS campaign using messages in local languages, prepared in consultation with both local and international health authorities. This quickly exceeded our pooled capacity. By then, Suvita and others were already working on similar initiatives, so we decided to stand by our original plan and reach those reachable through Facebook and our website.

Most of our audience were residents of the city of Kolkata in West Bengal. In a working paper released in June, Banjeree et al described an experiment of a much larger scale but similar context, conducted in West Bengal, the results of which were encouraging, i.e. by showing increased estimated handwashing when returning home by 7% (p = 0.044)^[5].

The results of our own survey weren’t nearly as informative, first because it didn’t hold to the same methodological standard (also because of capacity constraints), and second, because it only gathered 31 responses (despite various approaches used to promote it). Those who responded reported that thanks to @stayhomecampaign, they mostly keep distance from others more often, wash their hands more often, and cover their mouth when coughing or sneezing more often.

We used the campaign to promote two other surveys, one run by an international team of academics across 12 different international institutions (covid19-survey.org), another one by a team of academics at Monash University and Australian Catholic University (scrubcovid19.org). For both, we used paid ads to maximise click rate. The cost per click for an ad leading to that first survey was 0.015 USD. In contrast, it was already 0.11 USD for the second survey, which was promoted in July, after the campaign had already lost its original momentum. In both cases, the number of clicks wouldn’t correspond well with that of conversions. The cost per completed survey was 4.75 USD for the second ad. We haven't measured this for the first survey, but the cost wasn’t appealing enough for the team to pursue this long-term.

In May, we accepted the invitation to join the Pandemic Action Network, which “advocates for policy changes and increased support and resources to ensure countries are better prepared to prevent, detect and respond to pandemic threats”. Among the members of that network are African Union, Africa CDC, Bill and Melinda Gates Foundation, as well as John Hopkins Center for Communication Programs. We’re currently adjusting @stayhomecampaign to focus on our shared priorities.

Looking forward

Despite the turbulent events of 2020, the Policy Entrepreneurship Network remains on course to deliver on its mission. The Price of Smoking Campaign is back on track and already scaling up. Its aim is to support the cases made by those who advocate for higher taxes on tobacco products, not only in Ukraine but anywhere in the world. We’re constantly scanning for other opportunities in this space, as well as scoping a similar intervention in other areas of public health policy. Our plans for 2021 include an initial evaluation of this approach.

We’re looking forward to opening our Network to the 2020 Charity Entrepreneurship cohort, to share our resources and our mission to innovate the important, yet neglected areas of health policy across the world, in a way that emphasises the role of local organisations.

The @stayhomecampaign is in maintenance mode. We aim to establish a new strategy that fits the character and mission of the Pandemic Action Network while keeping our focus on areas of public activity that are neglected as much as they’re important.

Our top internal priority for 2021 is to fund the positions of both co-founders, one of which is currently open. In the recruitment process, we’re giving priority to candidates with a strong background in public health advocacy, health economics, and/or quantitative social sciences (you can read more here).

We’re also in need of hiring contractors in various capacities, and a Development Manager to drive the growth of the Network in terms of both partnerships and funding (you can read more here).

We’re currently fundraising to close the gap of $96,924.00 (low budget) or $180,224.00 (high budget) that will allow the Policy Entrepreneurship Network to grow throughout 2021. You will find the most current information on how to donate on our website: policyentrepreneurs.org/donate. We’re grateful for any amount of support we receive.

We would like to express our gratitude to Charity Entrepreneurship for providing seed funding and ongoing support to our organisation, and to the Effective Altruism community for your support and feedback.

---

1. Krasovsky, K. S. (2010). “The lobbying strategy is to keep excise as low as possible” - Tobacco industry excise taxation policy in Ukraine. ↩︎

2. Hassan, N., Tholasy, S., Ismail, N., Hasan, H., M. Nor, N., Thinng, W. B. K. (2019). Addressing the Illicit Flow of Tobacco Products. Confronting Illicit Tobacco Trade: A Global Review of Country Experiences. ↩︎

3. Ross, H., Shariff, S., & Gilmore, A. (2008). Economics of tobacco taxation in Ukraine. ↩︎

4. Krasovsky, K. S. (2010). “The lobbying strategy is to keep excise as low as possible” - Tobacco industry excise taxation policy in Ukraine. ↩︎

5. Banjeree, A., Alsan, M., Breza, E., CHandrasekhar, A. G., Chowdhury, A., Duflo, E., Goldsmith-Pinkham, P., Olken, B. A. (2020). Messages on COVID-19 Prevention in India Increased Symptoms Reporting and Adherence to Preventive Behaviors Among 25 Million Recipients with Similar Effects on Non-recipient Members of Their Communities. ↩︎