Good morning, John. It's occurred to me several times in the last few months that people mostly never know it when they don't die. Like, I do. I got a cancer, a kind of disease that is often fatal. And then I got medicine for it. And now it seems like I will die of something else. So, I know that I didn't die.

But I also got a vaccine for measles when I was young. And so did everyone around me. And so I've never had measles and probably never will. Now, if I had gotten measles, the chance that it would have killed or disabled me permanently is very low, but not zero. Before the measles vaccine, roughly 100% of kids got measles before they turned 15.

So my high school, which had around 2,000 students, would have had two or three or four fewer students because the measles death rate is somewhere between one and two per thousand kids. But here's the thing.

We do not know which three kids would have died.

That's the cruelty of probability. It feels like a game of chance, but for the kid who dies, it's not a one in 330 shot. It's 100%.

And this is the weird, frustrating, beautiful thing about prevention. When it works, nothing happens. There's no story. There are no first responders, no Hank-beat-measles party, no documentary films. Just a bunch of parents taking their kids to school who in another world wouldn't be doing that.

And so many things are like this. In 1963, the US passed the Clean Air Act. And in 1990, we passed the Clean Air Act amendments. The EPA estimates that in 2020, just the 1990 amendments saved 230,000 lives.

Hundreds of thousands of people who just kept on living, who didn't have a heart attack or a stroke or an asthma attack or a lung cancer diagnosis. They never knew they were in danger. No one knows which of the people they are.

There's no party. There's no parade. There's just people who aren't dead.

Mandated smoke detectors cut the risk of dying in a house fire in half. Banning lead in paint and gasoline preserved the IQs and health of millions of kids, but no one ever celebrates the brain damage they didn't get. Guardrails, rumble strips, and roundabouts prevent tens of thousands of road deaths every year without fanfare. Modern building codes mean earthquakes and hurricanes don't kill nearly as many people as they used to. And it isn't just the difference between the 1850s and now, though that is also huge. Food safety initiatives have decreased foodborne illnesses by 65% since 1998!

I am so happy that we understand first responders as the heroes that they are. But I'd also love it if I could feel the same way about people who made it so that the first responders arrived to a living human person sitting crying on the side of the road rather than someone having to receive the worst phone call of their life.

And I think about this in the context of this community's work in Sierra Leone. Already fewer women are dying in childbirth. And that victory is so quiet.

If 3,000 women in West Africa were trapped in a fallen building, there would be international news stories about it. There would be outcry to save them. But if 30,000 women each have a 10% chance of dying in childbirth, that's the same 3,000 deaths.

But due to, I think, just the way the human mind works, we are incapable of seeing that as the same kind of catastrophe and fixing it as the same kind of heroism.

We need to get way better at accepting the miracle of things that didn't happen because that's where some of humanity's greatest victories are hiding. And if we don't understand that, the things that didn't happen might very well begin happening again.

John, I'll see you on Tuesday.