When considering the impact of a donation to AMF, we should compare the expected mortality benefit if AMF distributes bednets compared to if they do not. According to their website, AMF did not make any significant bednet distributions before 2019, with just 1.4m nets across 2014-2016 for a population of around 75m. This means the counterfactual for AMF not making distributions in future is the same as the past, and that the current mortality rate of 7.7 per 1,000 child years is maintained. There is no reason to consider an increase to 11.9 or any other number if there are no future AMF distributions since there have been almost no past AMF distributions in this country
If AMF distributed 1.4m nets across 2014-16, then that’s a lot of children with nets. Say 2.8m, if it’s 2 children per net. If nets work, then these children will be protected to some extent, and have reduced mortality from malaria. An absence of future AMF bednet distributions (and an absence of an alternative) would result in increased mortality for these children.
Now, there’s the question of whether Givewell are right to indicate mortality would increase from 7.7 to 11.9. If these are country-level figures, in a country which mostly doesn’t have bednets, then plausibly mortality for those who do have bednets is actually lower than the country-level average of 7.7. Then, if the AMF bednets are stopped, we might expect an increase in mortality back up to the country average of 7.7. However, it may be that Givewell have already adjusted for this (I haven’t looked into it), and actually the 11.9 is indeed the country-level figure that the mortality rate would be expected to increase back up to.
(a minor point—it would be helpful if you edited this to indicate you’re discussing the Democratic Republic of Congo; I initially thought you were making claims about AMF’s total distributions)
Thanks for your comments. Agree with your suggested edit—there’s now two references to the Democratic Republic of Congo. Note that for the 2021 v2 model this is AMF’s total distributions as no other countries were expected to get distributions but regardless it’s worth stating explicitly.
Net distributions cover the whole community, they are not targetted at just under-5s. Using GiveWell’s figures, 16% of the population is under 5. Scaled up 1.8 people per net this suggests coverage for 1.4m * 16% * 1.8 = 0.4m young children. That’s not going to materially change the mortality rate in a country with c.12m under 5s.
Also any protection from 2014-2016 distributions would be massively diluted by the time you measure the mortality rate in 2019, which is when the 7.7 number comes from. GiveWell estimates that DRC bednets effectively last 1.74 years on average.
I can confirm that the 7.7 mortality rate is an unadjusted country-wide mortality rate and 11.9 is the rate GiveWell estimates would occur with no distributions from AMF.
Thanks for your response—and more generally, thanks for putting time and effort into scrutinising GiveWell’s analysis, and sharing your views here.
Net distributions cover the whole community, they are not targetted at just under-5s. Using GiveWell’s figures, 16% of the population is under 5. Scaled up 1.8 people per net this suggests coverage for 1.4m * 16% * 1.8 = 0.4m young children.
You’re of course right. I originally wrote ‘people’ rather than ‘children’, but changed it because the discussion was focused on under 5 mortality.
That’s not going to materially change the mortality rate in a country with c.12m under 5s.
Sure—but the question is whether it changes the mortality rate of those receiving the bednets.
I think you may be right, and it seems like GiveWell may have made a mistake here. But that doesn’t mean the mortality rate would be unchanged for those who receive (or would receive) bed nets. Rather, as I suggested before:
mortality for those who do have bednets might be lower than the country-wide mortality rate. e.g. if bednets reduce mortality by 17%, then we might assume the mortality rate with bednets goes from 7.7 to ~6.4.
then, if the AMF bednets are stopped, we might expect an increase in mortality back up to around the country average (which we presume indicates the mortality rate of those without bednets). So the increase would be 6.4 back to 7.7.
I agree for those that get a net it’s a good thing and mortality is reduced, and also agree mortality would increase again if no further nets appeared. However this point isn’t material given the volumes involved. 0.4m children at a rate of 6.4 and 11.6m at a rate of 7.7 is an average rate of 7.66 for the 12m children in total.
Even this small effect is diluted further when you consider the 6.4 rate only applies for 1. 74 years after the 2014-2016 distributions, so much lower when you measure mortality in 2019.
Previous AMF distributions fall into the level of rounding error in this counterfactual, which is why I’m saying an uplift from 7.7 to 11.9 is unreasonable.
I’m not sure I follow your point about volumes. The cost-effectiveness model is for those who receive the net. There’s no need to dilute the impact on these people merely because other people don’t experience the same impact. You just say ‘this is the benefit to these people, achieved at this cost’.
I think we both agree that bednets give a 17% reduction in mortality. The question is what mortality rate to apply this 17% to.
GiveWell say 11.9.
I say 7.7.
Based on your points I thought you were either saying (a) 7.7, agreeing with me, (b) an adjusted version of 7.7, which I calculate to be 7.66. Either way we’re agreeing here.