Iāve responded to some of Carneadesā points on how AMF might affect local economies on a separate thread. Iām not an expert on global health or economics, but it was hard for me to put together a compelling story where the local economic considerations led to nets being substantially less beneficial, much less net-negative (no pun intended).
If any of what Iāve written sounds off to you, please let me know! I was hoping for some kind of critical/āchallenging response, but no one really noticed the comment.
An excerpt:
The story where AMF has a major negative impact seems to indicate some combination of:
Lots of people taking free nets who would otherwise have bought them locally, to the extent that the local manufacturer goes out of business, and
Demand for nets not shooting back up once the AMF nets wear out and there are no more free net options, or
There being no one who has the ability + desire to start a net business, even though economic conditions prior to AMF allowed at least one such business to succeed and a huge number of people now need new nets
...and finally, the health and productivity benefits of much higher net coverage for a few years not outweighing the losses that come from slightly lower net coverage for some amount of time after that.
I say āslightly lowerā because, based on the coverage data above, it seems like few people in the areas AMF covers actually had nets in the first place ā if an area jumps from 20% coverage to 80% coverage, then drops to 0% coverage, the 0% condition has to persist for quite some time to negate the 80% condition.
Two different people told us in off-the-record conversations that they thought that this occurred because the mothers offered subsidized bednets believed that they would be able to acquire free nets at some other point. There have been periodic free ITN distributions in many sub-Saharan African countries over the last decade, and the international consensus seems to be that governments should distribute ITNs free of charge in malaria-endemic areas. Accordingly, it should not be especially surprising that citizens may expect bednets to be provided free of charge, and may not move to purchase them even if they are available at subsidized prices in the marketplace. If we reasonably expect to be given something for free in a relatively short time window, why buy it now?
If this happens in a minority of locations, we may just accept thatās the cost of doing business. In order to do a large amount of good overall we accept weāre going to do a small amount of harm. If it happens in a large number of locations, the harm is increased.
Agree with the logic of your last bullet above, though I donāt know the difference in difference in impact between 20% coverage and 80% coverage. It isnāt necessarily linearācould be better or worse than thatāand from memory the RCTs here all had universal coverage so no insight from there.
In terms of other stories where distributions may be net negative, I outlined a few in the comments recently. For citizens, workers, business owners and governments there may be wider impacts beyond the market-demand-for-nets idea youāve described above. How important you think those ideas are probably depends on how you think the economy really works and what might promote or prevent future growth.
A belated thanks for this reply! Iāve reached the end of my knowledge/āspare time for research at this point, but Iāll keep an eye out for any future posts of yours on these topics.
Iāve responded to some of Carneadesā points on how AMF might affect local economies on a separate thread. Iām not an expert on global health or economics, but it was hard for me to put together a compelling story where the local economic considerations led to nets being substantially less beneficial, much less net-negative (no pun intended).
If any of what Iāve written sounds off to you, please let me know! I was hoping for some kind of critical/āchallenging response, but no one really noticed the comment.
An excerpt:
Thanks Aaron for this comment, and the longer one you made elsewhere.
On the excerpt, I think thereās anecdotal evidence for bullet points 1-3 in a few places. GiveWell mention this in an old blogpost about people not buying subsidised nets:
If this happens in a minority of locations, we may just accept thatās the cost of doing business. In order to do a large amount of good overall we accept weāre going to do a small amount of harm. If it happens in a large number of locations, the harm is increased.
Agree with the logic of your last bullet above, though I donāt know the difference in difference in impact between 20% coverage and 80% coverage. It isnāt necessarily linearācould be better or worse than thatāand from memory the RCTs here all had universal coverage so no insight from there.
In terms of other stories where distributions may be net negative, I outlined a few in the comments recently. For citizens, workers, business owners and governments there may be wider impacts beyond the market-demand-for-nets idea youāve described above. How important you think those ideas are probably depends on how you think the economy really works and what might promote or prevent future growth.
A belated thanks for this reply! Iāve reached the end of my knowledge/āspare time for research at this point, but Iāll keep an eye out for any future posts of yours on these topics.