Today's Wisdom featuring David Miliband

Welcome back to A Little Wiser. Today, we’re honored to feature a guest contribution from former British Foreign Secretary and current President of the International Rescue Committee (IRC), David Miliband.

David’s feature explores the 'Zero-Dose' crisis that leaves millions of children without a single vaccination. It’s a sobering look at how geography often dictates destiny, and what it takes to change that map. This is an edition worth your undivided attention. As always, we hope you enjoy these three diverse lessons. Today’s wisdom:

Let’s dive in.

By David Miliband

Fourteen million children worldwide have never received a single vaccine dose. Read that number again. Fourteen million. These are not statistics but infants whose life chances are compromised at birth.

These “zero-dose” children reach their first birthday without even the first dose of basic vaccines like DTP (diphtheria, tetanus, and pertussis). They illustrate a stark inequality: global vaccination rates hover around 89%, yet these children are entirely left behind.

Over half live in just nine countries: Nigeria, India, Sudan, Democratic Republic of Congo, Ethiopia, Indonesia, Yemen, Afghanistan, and Angola. And the inequity runs deeper: a quarter of the world’s infants live in 26 conflict-affected or humanitarian settings, yet they account for half of all unvaccinated children globally. In half of these fragile settings, the number of unvaccinated children has exploded from 3.6 million in 2019 to 5.4 million in 2024.

The causes converge: conflict makes health delivery dangerous; climate-driven disasters displace families and destroy infrastructure; some communities are nomadic or displaced across international borders; others are in areas where governments cannot reach.

The result is communities vulnerable to preventable diseases—measles, polio, tetanus—eliminated elsewhere decades ago. This is not only a human tragedy, but a risk to regional and global health security.

Reaching these children requires a different model: humanitarian negotiation to access conflict zones; geospatial mapping to find zero-dose populations; portable cold chain equipment that works without reliable electricity; and integrating vaccination into humanitarian response rather than treating it as a separate vertical.

The IRC-led REACH consortium - funded by Gavi, the Vaccine Alliance - has shown this can work. When the program began, only 16% of target communities in conflict-affected areas were accessible. Through principled negotiation, IRC and partners are today able to reach all targeted communities. With mobile clinics, local partnerships, and technology to track displacement, REACH has delivered over 24 million vaccine doses, including in some villages that had not seen a vaccinator for over a decade. As we have scaled, delivery costs have fallen to around $2 per dose—proof that reaching zero-dose children in fragile settings is both possible and affordable.

The question is no longer how to reach these children—we know that. It is whether we have the political will and resources to scale these approaches, so that being born in a conflict or climate-affected region does not mean being denied life-saving protection.

Rather than reacting to the pleasure of a result, dopamine surges during the anticipation of a reward. This is why the mere act of reaching for your phone feels more compelling than the content you eventually find. Neuroscientists have shown that unpredictable rewards trigger the strongest dopamine release, the same mechanism behind slot machines. Social media feeds, notifications, and endless scrolling exploit this perfectly: variable likes, surprise content, and infinite refresh loops keep dopamine flickering just enough to hold your attention hostage. By keeping us in a state of perpetual anticipation, these platforms ensure we stay engaged not because we are satisfied, but because we are perpetually seeking satisfaction that never quite arrives.

Dopamine operates relative to a sliding scale; when constant high-stimulation inputs like scrolling and multitasking flood the system, your baseline rises, making ordinary life feel dull by comparison. This reflects what neuroscientists call the "readily releasable pool" of dopamine: by constantly tapping into your supply for quick hits, you deplete the very reservoirs needed for sustained drive. Research in behavioral psychology shows that when your dopamine levels inevitably dip below this inflated baseline, you enter a "pain" state characterized by restlessness and irritability. It is in this neurological trough that boredom becomes unbearable, driving the reflexive urge to reach for a phone during meals or workouts. Ultimately, modern tech hasn't just stolen our time; it has taxed our ability to feel satisfied by quiet things.

The fix is in retraining how you access it. Simple rules help to protect your baseline: don't use social media while eating or exercising; avoid having your phone in the room during deep work; and reintroduce low-stimulation activities like reading or walking without music or podcasts. Switching your phone display to grayscale removes the attentional bait of bright red notification bubbles and vibrant app icons. Embrace the 60 seconds of boredom between tasks. Instead of switching from a meeting straight to an email, sit in silence for one minute as this prevents attention residue from one task bleeding into the next. One of the most powerful tools for recalibrating focus is learning to attach dopamine to the effort itself rather than the end reward. Studies on "growth mindset" show that when you focus on the friction and the challenge of a task, you can evoke dopamine release during the work. In a world designed to fragment attention, protecting dopamine is less about self-control and more about redesigning how and when you give your brain a reward.

Below - This graph illustrates a striking correlation between the rise of digital technology adoption and declining mental health outcomes among U.S. young adults. Researchers often link this to the dopamine flooding and depletion cycle.

Long before it became a household staple of ruthless deal-making, Monopoly was actually a Trojan horse designed to expose the dangers of land grabbing. In 1904, a little-known American inventor named Elizabeth Magie created The Landlord’s Game, designed to demonstrate how monopolies concentrate wealth and impoverish everyone else. The board already had familiar elements: rent, property ownership, and the slow squeezing of players who fell behind. However, Magie’s intent was educational, even moral. She was a follower of economist Henry George, who believed land ownership should benefit society as a whole. Ironically, the lesson most players took from the game was not “monopolies are bad,” but “it’s fun to crush your friends financially.” As the game spread informally through college towns and living rooms, house rules evolved, names changed, and its original critique quietly evaporated.

Enter Charles Darrow, an unemployed heating salesman riding out the Great Depression. In the early 1930s, Darrow encountered one of these homemade property-trading games and immediately saw what others had missed: not just a pastime, but a product. He redrew the board using Atlantic City street names, polished the artwork, and, most importantly, reframed the experience as a fantasy of escape and upward mobility at a moment when both were scarce. When he first pitched the game to Parker Brothers, they rejected him calling Monopoly too long and too complex. However, after Darrow’s homemade sets started selling thousands of copies, they reversed course. In 1935, Parker Brothers bought the rights from Darrow, turning him into the first board-game millionaire. Only later did the company quietly acquire Elizabeth Magie’s original patent for a token sum. The game meant to critique economic inequality had become a commercial juggernaut built on it.

What followed was one of the most successful board games in history, translated into dozens of languages and sold in over 100 countries. Monopoly endures not because it’s balanced or fair, most games are mathematically decided early on, but because it dramatizes a deep human tension between luck, strategy, and power. It teaches, perhaps unintentionally, the same lesson Magie hoped players would learn a century ago: once monopolies form, the game stops being fun for everyone else.

Below - The strategy that helps you win this classic board game….

We hope you enjoyed today’s edition. A special thanks to David Miliband for his impactful guest feature. The International Rescue Committee (IRC) responds to the world’s worst humanitarian crises, helping people to survive, recover, and gain control of their future. From delivering life-saving vaccines in conflict zones to providing clean water and education, their impact is felt in over 40 countries.

If David’s words moved you, we encourage you to explore the IRC’s work further. Whether it’s staying informed or contributing to their mission, every bit of support helps "change the map" for those who need it most.

Until next time…. - A Little Wiser Team

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