Merely subsidizing nets, as opposed to free distribution, used to be a much more popular idea. My understanding is that that model was nuked by this paper showing that demand for nets falls discontinuously at any positive price (60 percentage points reduction in demand when going from 100% subsidy to 90% subsidy). So unless people’s value for their children’s lives are implausibly low, people are making mistakes in their choice of whether or not to purchase a bednet.
New Incentives, another GiveWell top charity, can move people to vaccinate their children with very small cash transfers (I think $10). The fact that $10 can mean the difference between whether people protect their children from life threatening diseases or not is crazy if you think about it.
This is not a rare finding. This paper found very low household willingness to pay for cleaning up contaminated wells, which cause childhood diarrhea and thus death. Their estimates imply that households in rural Kenya are willing to pay at most $770 to prevent their child’s death, which just doesn’t seem plausible. Ergo, another setting where people are making mistakes. Another; demand for motorcycle helmets is stupidly low and implies that Nairobi residents value a statistical life at $220, less than 10% of annual income. Unless people would actually rather die than give up 10% of their income for a year, this is clearly another case where people’s decisions do not reflect their true value.
This is not that surprising if you think about it. People in rich countries and poor countries alike are really bad at investing in preventative health. Each year I dillydally on getting the flu vaccine, even though I know the benefits are way higher than the costs, because I don’t want to make the trip to CVS (an hour out of my day, max). My friend doesn’t wear a helmet when cycling, even at night or in the rain, because he finds it inconvenient. Most of our better health in the rich world doesn’t come from us actively making better health decisions, but from our environment enabling us to not need to make health decisions at all.
I’m pretty sure the personal benefits of getting the flu vaccine for a male in their 20-30s is not much higher than the costs. Agree on the bike helmet thing though.
I don’t know enough about AMF to answer your question directly, but I can shed some light on market failures by way of analogy to my employer, Kaya Guides, which provides free psychotherapy in India:
Our beneficiaries usually can’t afford psychotherapy outright
They sometimes live rurally, and can’t travel to places that do psychotherapy in person
There are not enough psychotherapists in India for everyone to receive it
The government, equally, don’t have the capacity or interest to develop the mental health sector enough (against competing health priorities) to make free treatment available
Our beneficiaries usually don’t know what psychotherapy is, or that they have a problem at all, nor that it can be treated
We are incentivised to make psychotherapy as cheap as possible to reach the worst-served portion of the market, while for-profits are incentivised to compete in more lucrative parts of the market
I can see how many, if not all, of these would be analogous to AMF. The market doesn’t and can’t solve every problem!
That sounds pretty reasonable for why psychotherapy wouldn’t be as widespread as it should. It looks to me like most of these reasons wouldn’t apply to AMF. Training new psychotherapists takes years and tens of thousands of dollars (at developing-world wages). Getting more malaria nets requires buying more $5 malaria nets, and distributing malaria nets is much easier than distributing psychotherapists. So reasons 1–3 and #6 don’t carry over (or at least not to nearly the same extent). #4 doesn’t seem relevant to my original question so I think #5 is the only one that carries over—recipients might not know that they should be concerned about malaria.
Effective bednets have a relatively short shelf life due to both loss of insecticide and physical damage.
People in target regions can and do buy bednets, though for much of the target market the cost might still represent a day’s income so they won’t necessarily be inclined to replace them at optimal intervals. (On the other hand, it’s a tiny fraction of a typical GiveDirectly handout, which is probably why “people buy bednets with it” isn’t a major feature of their research even in regions with significant malaria). Consumers see [not necessarily as effective] alternative products purporting to achieve mosquito control in the same shops , and won’t necessarily prioritise purchasing replacement nets when it represents a large spend for them, their reason for doing so is the existing bednet doesn’t seem to be working, and people who are relatively informed about malaria prevention are also informed that governments and NGOs tend to dispense bednets for free… Programmes dispensing free nets tend to provide advice on using them properly too.
Bednets on sale in some local markets are often untreated, so buying replacements locally isn’t necessarily even a good decision.
How strong is the evidence for bednets being effective?
A priori there is a not unsurprising mistake the researchers could have made in reaching this conclusion & they would have an incentive to make such a mistake.
A priori bednets being very effective is a bit surprising.
What is the strongest study that supports this conclusion?
As Binka et al say “The original trials ran for only 1-2 years each. At the end of these periods, the efficacy of the intervention was considered proven and the control groups were provided with nets or curtains, thus these trials could not be used to demonstrate the effects of long-term transmission control.”.
Why does distributing malaria nets work? Why hasn’t everyone bought a bednet already?
If it’s because they can’t afford bednets, why don’t more GiveDirectly recipients buy them?
Is it because nobody in the local area sells bednets? If so, why doesn’t anyone sell them?
Is it because people don’t think bednets are worth it? If so, why do they use the bednets when given them for free?
Merely subsidizing nets, as opposed to free distribution, used to be a much more popular idea. My understanding is that that model was nuked by this paper showing that demand for nets falls discontinuously at any positive price (60 percentage points reduction in demand when going from 100% subsidy to 90% subsidy). So unless people’s value for their children’s lives are implausibly low, people are making mistakes in their choice of whether or not to purchase a bednet.
New Incentives, another GiveWell top charity, can move people to vaccinate their children with very small cash transfers (I think $10). The fact that $10 can mean the difference between whether people protect their children from life threatening diseases or not is crazy if you think about it.
This is not a rare finding. This paper found very low household willingness to pay for cleaning up contaminated wells, which cause childhood diarrhea and thus death. Their estimates imply that households in rural Kenya are willing to pay at most $770 to prevent their child’s death, which just doesn’t seem plausible. Ergo, another setting where people are making mistakes. Another; demand for motorcycle helmets is stupidly low and implies that Nairobi residents value a statistical life at $220, less than 10% of annual income. Unless people would actually rather die than give up 10% of their income for a year, this is clearly another case where people’s decisions do not reflect their true value.
This is not that surprising if you think about it. People in rich countries and poor countries alike are really bad at investing in preventative health. Each year I dillydally on getting the flu vaccine, even though I know the benefits are way higher than the costs, because I don’t want to make the trip to CVS (an hour out of my day, max). My friend doesn’t wear a helmet when cycling, even at night or in the rain, because he finds it inconvenient. Most of our better health in the rich world doesn’t come from us actively making better health decisions, but from our environment enabling us to not need to make health decisions at all.
I think this is the best explanation I’ve seen, it sounds likely to be correct.
I’m pretty sure the personal benefits of getting the flu vaccine for a male in their 20-30s is not much higher than the costs. Agree on the bike helmet thing though.
Alexander Berger answered pretty much this exact question on a old 80k episode
Felt a little scared realizing that that episode is over 3 years old. It’s such a great one and I return to it often!
I don’t know enough about AMF to answer your question directly, but I can shed some light on market failures by way of analogy to my employer, Kaya Guides, which provides free psychotherapy in India:
Our beneficiaries usually can’t afford psychotherapy outright
They sometimes live rurally, and can’t travel to places that do psychotherapy in person
There are not enough psychotherapists in India for everyone to receive it
The government, equally, don’t have the capacity or interest to develop the mental health sector enough (against competing health priorities) to make free treatment available
Our beneficiaries usually don’t know what psychotherapy is, or that they have a problem at all, nor that it can be treated
We are incentivised to make psychotherapy as cheap as possible to reach the worst-served portion of the market, while for-profits are incentivised to compete in more lucrative parts of the market
I can see how many, if not all, of these would be analogous to AMF. The market doesn’t and can’t solve every problem!
That sounds pretty reasonable for why psychotherapy wouldn’t be as widespread as it should. It looks to me like most of these reasons wouldn’t apply to AMF. Training new psychotherapists takes years and tens of thousands of dollars (at developing-world wages). Getting more malaria nets requires buying more $5 malaria nets, and distributing malaria nets is much easier than distributing psychotherapists. So reasons 1–3 and #6 don’t carry over (or at least not to nearly the same extent). #4 doesn’t seem relevant to my original question so I think #5 is the only one that carries over—recipients might not know that they should be concerned about malaria.
Effective bednets have a relatively short shelf life due to both loss of insecticide and physical damage.
People in target regions can and do buy bednets, though for much of the target market the cost might still represent a day’s income so they won’t necessarily be inclined to replace them at optimal intervals. (On the other hand, it’s a tiny fraction of a typical GiveDirectly handout, which is probably why “people buy bednets with it” isn’t a major feature of their research even in regions with significant malaria). Consumers see [not necessarily as effective] alternative products purporting to achieve mosquito control in the same shops , and won’t necessarily prioritise purchasing replacement nets when it represents a large spend for them, their reason for doing so is the existing bednet doesn’t seem to be working, and people who are relatively informed about malaria prevention are also informed that governments and NGOs tend to dispense bednets for free… Programmes dispensing free nets tend to provide advice on using them properly too.
Bednets on sale in some local markets are often untreated, so buying replacements locally isn’t necessarily even a good decision.
How strong is the evidence for bednets being effective?
A priori there is a not unsurprising mistake the researchers could have made in reaching this conclusion & they would have an incentive to make such a mistake.
A priori bednets being very effective is a bit surprising.
What is the strongest study that supports this conclusion?
The evidence is quite strong. You can most likely get more detail than you ever wanted from the GiveWell review.
Thanks.
It seems like there are 4 studies with extended follow up—Binka et al https://doi.org/10.1016/S0035-9203(02)90321-4 , Diallo et al https://pmc.ncbi.nlm.nih.gov/articles/PMC2585912/ , Lindblade et al https://doi.org/10.1001/jama.291.21.2571 , Louis et al https://doi.org/10.1111/j.1365-3156.2012.02990.x—but not of the type that would be directly informative.
As Binka et al say “The original trials ran for only 1-2 years each. At the end of these periods, the efficacy of the intervention was considered proven and the control groups were provided with nets or curtains, thus these trials could not be used to demonstrate the effects of long-term transmission control.”.