In this comment I list out some questions and curiosities related to coordination between GiveWell and BMGF and other funders. I don’t actually need answers to them, so don’t worry about addressing them if doing so isn’t easy:
In September 2021, we recommended a small grant to Malaria Consortium and PATH to assess the feasibility and cost-effectiveness of implementing IPTi at national scale in two countries.
I notice that this Malaria Consortium document that GiveWell is hosting on its site says there’s a study funded by the Bill & Melinda Gates Foundation that “will assess IPTi’s clinical effectiveness and operational feasibility in Nigeria,” and that the project runs from November 2020 – October 2024.
It sounds like GiveWell and BMGF both decided to fund MC to do a study on IPTI effectiveness at a similar time.
Also from the MC doc:
However, a decade after WHO’s recommendation, only one country — Sierra Leone — has adopted the strategy as national policy.
It seems unlikely to me that the two studies are starting around the same time by coincidence given that they are both happening about a decade after WHO’s recommendation.
Can GiveWell say what the explanation for this is? E.g. Did one of GiveWell or BMGF influence the other to start a study? Or is MC responsible for reaching out to both to incite a study? Or has BMGF actually been funding studies on this for years and I came across this recent study just because its their latest study on IPTi?
I also wonder whether there is likely a lot more low-hanging fruit like this—policy proposals from several years ago that seem this cost-effective and that can make use of $50-$200M (~16k-67k lives saved) or more but that haven’t been implemented yet because no institution is systematically following up on these recommendations to confirm their cost-effectiveness and implement them as soon as possible if worthwhile.
If so, does GiveWell have a plan to change this so that these sort of opportunities don’t go unfunded for a decade anymore? Is the answer to just hiring more researchers to look for these opportunities until it’s no longer worthwhile to pay more researchers to search?
Counterfactual impact of our funding – It might be that another funder would step in to support IPTi implementation in the next few years if we don’t, thus reducing the value of our funding recommendation.
It seems like the most obvious other candidate funder for this is the BMGF.
Also given that WHO originally recommended this intervention, might it be possible to get WHO to help fund much or all of it (assuming GiveWell decides it is worth funding and finds organizations able to implement IPTi)?
I’m curious if GiveWell dedicates significant attention to coordinating with other funders like BMGF and WHO for the purpose of negotiating their help in funding these worthwhile interventions.
On the one hand it’ll be great for GiveWell’s public image / reputation if GiveWell can say that it funded $50M in donations to IPTi at 18x cash, but on the other hand if GiveWell can get another funder to fund the opportunity instead that seems even better (assuming that the other funder’s spending is less cost-effective than GiveWell’s on average, since it frees up more of GiveWell’s money to spend on programs more cost-effective than the programs the other funder would have funded), even if that makes it harder for GiveWell to get social credit for the impact.
Thanks for your patience and flexibility! Though you said you weren’t necessarily expecting a response, we do try to answer comments promptly, and I apologize that it took a while to get back to you on this.
This answer may not cover every question you raised, but I think it will get at most of it.
On the timing of the two IPTi scoping grants:
We believe the concurrence of these grants is related to a general growing interest in IPTi as a promising tool with which to combat malaria, especially as progress against the disease has plateaued in recent years (see WHO’s 2021 World Malaria Report for more on this) and infants remain vulnerable. Other global actors are also making investments in IPTi; for example, Unitaid has funded the IPTi+ implementation research project, which aims to test out delivery models for the intervention while administering IPTi at scale. WHO is also set to release updated, less restrictive guidelines for administering IPTi, which should make it easier for some countries to adopt it. (We describe the current WHO guidelines in more detail, and discuss other factors that may have inhibited more widespread adoption, here.)
We did speak with Gates to coordinate before we recommended our own scoping grant to Malaria Consortium and PATH, to make sure that we weren’t duplicating efforts. The goals of the two grants are a bit different. The Gates-funded study is aimed at learning more about the feasibility and effectiveness of IPTi in real-world settings (as opposed to trial settings), and generating evidence to support IPTi’s adoption among policymakers in Nigeria. Our grant was less focused on evidence generation—we funded PATH and Malaria Consortium to gather information that will inform our cost-effectiveness analysis, and to put together a proposal for scaled-up IPTi implementation in Nigeria and DRC, including costs, timeline, and delivery platforms (more information here).
On the possibility of Gates funding a larger-scale IPTi program:
We’ve talked to Gates and other large funders about whether they’re likely to fund IPTi at scale soon, and it seems most of them are waiting for the results of the Gates and Unitaid research before deciding whether to do so. That would mean waiting on funding implementation until at least 2024 or 2025. One of the goals of our scoping grant is to learn whether there are opportunities to accelerate implementation of IPTi even before those other studies are concluded (see our thinking under “Waiting on more evidence generation vs. moving ahead now” in the “risks and reservations” section of the grant page).
We also get the impression that some of the big funders in the malaria space have institutional mandates that wouldn’t allow them to support technical assistance to help scale up IPTi, which is what we’re interested in potentially funding. (These funders might instead support, for example, ongoing drug procurement for IPTi once the program is already being delivered at scale.)
On coordinating with Gates or WHO to get more funding: One of the factors we consider before recommending any grant is the possibility of leverage (i.e., our grant causes other funders to invest more money in the same intervention) or funging (our grant means other funders decide not to invest in the same intervention). Leverage is a good thing for the world, since we believe most other funders would, counterfactually, fund something less cost-effective than the opportunities we’re interested in. One big question for us as we consider future support of IPTi is whether our funding would actually be a deciding factor in other funders supporting IPTi, since we know that interest in this intervention is already growing—it might be that they would have funded IPTi anyway, without our grant. We have been speaking with Gates, WHO, Unitaid, President’s Malaria Initiative, and other big actors to learn what barriers they have to funding IPTi implementation, and what we could do, beyond the ongoing evidence generation efforts, to help crowd in more funds. We’ll continue to have conversations with them to get a sense of how our funding affects their decision-making.
On other interventions that are recommended by WHO but not yet scaled: We do think this, or something like this, could be a promising avenue. We’re aware of a few other interventions for which the evidence seems strong, but there are no NGOs currently implementing the program, and we’re looking into how we might find or create funding opportunities for those interventions.
Thank you, Miranda, the context you provided is indeed very helpful and satisfies my curiosity.
I also want to add that all the communication I’ve seen from GiveWell with the public recently has frankly been outstanding (e.g. on rollover funding). I’m really impressed and appreciate the great work you all are doing, keep it up!
In this comment I list out some questions and curiosities related to coordination between GiveWell and BMGF and other funders. I don’t actually need answers to them, so don’t worry about addressing them if doing so isn’t easy:
I notice that this Malaria Consortium document that GiveWell is hosting on its site says there’s a study funded by the Bill & Melinda Gates Foundation that “will assess IPTi’s clinical effectiveness and operational feasibility in Nigeria,” and that the project runs from November 2020 – October 2024.
It sounds like GiveWell and BMGF both decided to fund MC to do a study on IPTI effectiveness at a similar time.
Also from the MC doc:
It seems unlikely to me that the two studies are starting around the same time by coincidence given that they are both happening about a decade after WHO’s recommendation.
Can GiveWell say what the explanation for this is? E.g. Did one of GiveWell or BMGF influence the other to start a study? Or is MC responsible for reaching out to both to incite a study? Or has BMGF actually been funding studies on this for years and I came across this recent study just because its their latest study on IPTi?
I also wonder whether there is likely a lot more low-hanging fruit like this—policy proposals from several years ago that seem this cost-effective and that can make use of $50-$200M (~16k-67k lives saved) or more but that haven’t been implemented yet because no institution is systematically following up on these recommendations to confirm their cost-effectiveness and implement them as soon as possible if worthwhile.
If so, does GiveWell have a plan to change this so that these sort of opportunities don’t go unfunded for a decade anymore? Is the answer to just hiring more researchers to look for these opportunities until it’s no longer worthwhile to pay more researchers to search?
It seems like the most obvious other candidate funder for this is the BMGF.
Also given that WHO originally recommended this intervention, might it be possible to get WHO to help fund much or all of it (assuming GiveWell decides it is worth funding and finds organizations able to implement IPTi)?
I’m curious if GiveWell dedicates significant attention to coordinating with other funders like BMGF and WHO for the purpose of negotiating their help in funding these worthwhile interventions.
On the one hand it’ll be great for GiveWell’s public image / reputation if GiveWell can say that it funded $50M in donations to IPTi at 18x cash, but on the other hand if GiveWell can get another funder to fund the opportunity instead that seems even better (assuming that the other funder’s spending is less cost-effective than GiveWell’s on average, since it frees up more of GiveWell’s money to spend on programs more cost-effective than the programs the other funder would have funded), even if that makes it harder for GiveWell to get social credit for the impact.
Hi, William,
Thanks for your patience and flexibility! Though you said you weren’t necessarily expecting a response, we do try to answer comments promptly, and I apologize that it took a while to get back to you on this.
This answer may not cover every question you raised, but I think it will get at most of it.
On the timing of the two IPTi scoping grants:
We believe the concurrence of these grants is related to a general growing interest in IPTi as a promising tool with which to combat malaria, especially as progress against the disease has plateaued in recent years (see WHO’s 2021 World Malaria Report for more on this) and infants remain vulnerable. Other global actors are also making investments in IPTi; for example, Unitaid has funded the IPTi+ implementation research project, which aims to test out delivery models for the intervention while administering IPTi at scale. WHO is also set to release updated, less restrictive guidelines for administering IPTi, which should make it easier for some countries to adopt it. (We describe the current WHO guidelines in more detail, and discuss other factors that may have inhibited more widespread adoption, here.)
We did speak with Gates to coordinate before we recommended our own scoping grant to Malaria Consortium and PATH, to make sure that we weren’t duplicating efforts. The goals of the two grants are a bit different. The Gates-funded study is aimed at learning more about the feasibility and effectiveness of IPTi in real-world settings (as opposed to trial settings), and generating evidence to support IPTi’s adoption among policymakers in Nigeria. Our grant was less focused on evidence generation—we funded PATH and Malaria Consortium to gather information that will inform our cost-effectiveness analysis, and to put together a proposal for scaled-up IPTi implementation in Nigeria and DRC, including costs, timeline, and delivery platforms (more information here).
On the possibility of Gates funding a larger-scale IPTi program:
We’ve talked to Gates and other large funders about whether they’re likely to fund IPTi at scale soon, and it seems most of them are waiting for the results of the Gates and Unitaid research before deciding whether to do so. That would mean waiting on funding implementation until at least 2024 or 2025. One of the goals of our scoping grant is to learn whether there are opportunities to accelerate implementation of IPTi even before those other studies are concluded (see our thinking under “Waiting on more evidence generation vs. moving ahead now” in the “risks and reservations” section of the grant page).
We also get the impression that some of the big funders in the malaria space have institutional mandates that wouldn’t allow them to support technical assistance to help scale up IPTi, which is what we’re interested in potentially funding. (These funders might instead support, for example, ongoing drug procurement for IPTi once the program is already being delivered at scale.)
On coordinating with Gates or WHO to get more funding: One of the factors we consider before recommending any grant is the possibility of leverage (i.e., our grant causes other funders to invest more money in the same intervention) or funging (our grant means other funders decide not to invest in the same intervention). Leverage is a good thing for the world, since we believe most other funders would, counterfactually, fund something less cost-effective than the opportunities we’re interested in. One big question for us as we consider future support of IPTi is whether our funding would actually be a deciding factor in other funders supporting IPTi, since we know that interest in this intervention is already growing—it might be that they would have funded IPTi anyway, without our grant. We have been speaking with Gates, WHO, Unitaid, President’s Malaria Initiative, and other big actors to learn what barriers they have to funding IPTi implementation, and what we could do, beyond the ongoing evidence generation efforts, to help crowd in more funds. We’ll continue to have conversations with them to get a sense of how our funding affects their decision-making.
On other interventions that are recommended by WHO but not yet scaled: We do think this, or something like this, could be a promising avenue. We’re aware of a few other interventions for which the evidence seems strong, but there are no NGOs currently implementing the program, and we’re looking into how we might find or create funding opportunities for those interventions.
I hope that helps!
Best,
Miranda
Thank you, Miranda, the context you provided is indeed very helpful and satisfies my curiosity.
I also want to add that all the communication I’ve seen from GiveWell with the public recently has frankly been outstanding (e.g. on rollover funding). I’m really impressed and appreciate the great work you all are doing, keep it up!
Thanks, William, that’s great to hear!