This is a transcript for the AMA with Rob Mather, CEO of AMF, which I recorded live on the 19th of December. To listen to a recording of the live AMA as a podcast, follow the link above for the RSS feed, or:
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Thanks to Rob Mather for his time, and Dane Magaway for her help with this transcript.
AMA with Rob Mather, recorded 19th December â23
Toby Tremlett: Welcome to this live AMA with Rob Mather, CEO of the Against Malaria Foundation. Iâm Toby Tremlett, the EA Forumâs content manager. If youâre interested in effective altruism, youâve probably heard of Robâs charity, the Against Malaria Foundation. For almost two decades, theyâve been doing crucial work to protect people, especially children, from malaria.
To date, around 450 million people have been protected with malaria bed nets from this charity. Once all of their currently funded nets have been distributed, AMF estimates it would have prevented 185,000 deaths. And itâs not just AMF saying this, theyâve been a GiveWell Top Charity since 2009.
So to get straight into the AMA, weâre going to keep the answers pretty short and snappy. I think Rob said heâs going to stick to two minutes per answer. And yeah, Rob, thank you for making the time for coming along for this.
Rob Mather: Pleasure.
Toby Tremlett: On the theme of making the time, somebody said that theyâve organized two small fundraisers with AMF, and in both cases, you were incredibly proactive and helpful, taking time to immediately respond to emails and hop onto calls. They say many thanks, but a question remains, where do you find the time and which time management strategies do you use? You have two minutes of time.
Rob Mather: I donât use any particular strategies, Iâm afraid. I think what I would say is we certainly leverage technology here, so that a lot of the things that I perhaps would normally do as a CEO of a charity I donât do because technology takes over. And perhaps I can give a couple of examples.
One of the things that we have to do as a charity is we have to file our accounts. We have to do that, in our case, in 14 countries and there are typically between 10 and 15 documents we have to prepare for each country. Lots of documents, lots of information that would normally take months of a number of people probably putting that together. And we broadly have that content all available to us within nine hours of the end of our financial year because at the end of the day, finances are just ones and zeros so we can automate the living daylights out of it. And therefore a whole series of effort that would otherwise go into admin that would take my time effectively is struck down to just a sliver of time. I think thatâs one element [that] allows me to put my time in [another] direction.
The second thing I would say is that the structure of AMF is very streamlined. Weâre very focused on what we do. There is a lot of complexity in many ways around distributing nets, particularly around the operations. Thatâs the bit that really requires an awful lot of very careful attention to make sure nets get to people. And because we have a very simple series of steps, if you like, that we go through when weâre carrying out our work, weâre not a complicated organization. So strategically, certainly AMF has been designed to be operationally simple. I would say that that simplicity plus technology allows me to have more time in certain areas than perhaps other people might have
Toby Tremlett: Fantastic! That was almost bang on two minutes. Another question: what did you do before AMF? Did it lead naturally into this role or did it feel like a major career change?
Rob Mather: Major career change, really, because I certainly wasnât planning to be in this role. Did it lead into this role? In some ways, yes, because I guess the experiences that Iâve had and the things that Iâve learned over my career, Iâll go through it in 30 seconds, in a moment, I think allowed me to not be brilliant at anything, but allowed me to have experiences and some degree of capability across a whole series of areas. Therefore I could cover a lot of bases, particularly in an organization that just had two of us for the first 10 years. We grew to 50 million in revenue with just two of us because of some of those strategic choices about how we were organizing what we did.
When I left university, I studied chemical engineering at university. I went to join a strategy consulting firm. I went to live in Italy, work for a big American company and learned a lot in those four years about strategy, about business, and about getting things done. I then went to business school, learned a huge amount of business school over two years, went to the States. When I came back from the US, moved back to the UK and worked in an exhibitions business, a trade shows business, a very small company, so highly entrepreneurial. And I was effectively a commercial directorâI was in charge of one aspect of the organizationâs business, bringing in revenue with several others, not just me alone. That taught me all sorts of things about how to secure funding if you like. Then I worked in one of the worldâs largest financial publishers, and I set up a business within a PLC that taught me an awful lot about operations and making things happen and persuading people to do things. And that was the last step before I then effectively set up AMF.
A whole series of different experiences that meant that I felt it was worth giving a go to what I want to do with malaria.
Toby Tremlett: Fantastic. So, would you mind briefly telling the story of how you went from organizing a swimming fundraiser for a horrifically burned child to running one of the most effective global health charities in the world, in two minutes.
Rob Mather: Well, I suppose when we first set up AMF, there was a very simple aim: raise funds, purchase nets, distribute them so that they ended up over heads and beds, and make sure we had the data to prove it. In essence, that very simple approach is the approach we take today. If you layer on top of that very high levels of accountability being at the heart of what we do, we donât accept sort of trust and we donât accept, âwell, it probably happenedâ. Weâre ruthless about making sure we have the data to prove that what we say we will do happens. That is a very important or very helpful thing to be able to then be transparent about in talking to people about what youâre doing. In being accountable, you tend also to embrace efficiency. That combination of accountability at the heart of what we do, being really transparent, always aiming to be highly efficient in the way we go about our work means that in the causal area that is malaria that clearly independent of us, arguably, you know, is a strongly a highly impactful area to be operating inâthat combination, I guess, has led us to be independently judged by others to be, you know, pretty efficient and impactful at what we do.
Toby Tremlett: Fantastic. Yeah, I mean, itâs interesting, it often comes up in thinking around effective altruism, that it can be surprising that people donât focus on this kind of accountability and measurement when theyâre making charities. But it does seem to be the case that itâs not the thing that most people are thinking about when theyâre starting charities.
Why was that something that mattered to you? Yeah, I feel like when you had the popularity of this swimming fundraiser which like led into AMF it could naturally, you could have started a charity on something that was salient to you or something that was nearby. Why was it that malaria appealed?
Rob Mather: The reason that malaria was the focus was because when we organized a swim for a burns victim, a small child called Terry who was very badly burnt when she was two that led to 10,000 people swimming from a plan of having three people swimming. That was very surprising. I learned a number of interesting things from that. Most importantly, how terrific people can be in saying, âYep, weâll help.â
When the notion crossed my brain of trying to get a million people to do something the next year or in a couple of years time, when you think about where you want to direct the funds we might raise from that, it was very clearly low-income countries was was going to be of interest rather than high-income countriesânot heart disease and cancer, but HIV AIDS, TB, malaria, landmines, freshwater diarrhea, you know these sorts of issues whereas we all know there is a significant, the larger impact per dollar than in in the high-income countries.
When I discovered that, when I went through each of the six or seven things that I was considering and scratched beneath the surface, there were reasons to dismiss all the others, but seven jumbo jets full of children under five, or the equivalent thereof, dying every day from malaria, and it being the single largest disease killer of pregnant women in the world, yet the most effective thing we could do was have people sleep under a bed net was something that was pretty engaging. And I like the idea of raising money for nets rather than for drugs. You know, big bad pharmaceutical companies might come to mind for some people. So malaria was the obvious target and 5 million nets were going out at that time and the need was 205 million. And so there is a gap. Letâs see if I can do something to try and help that.
Toby Tremlett: Yeah, I mean, itâs fantastic. It makes total sense in retrospect as well. I was just wondering at the time, had you been thinking about global health before that, or was it just the size of the amount of money you thought I might be able to raise that made you think about it in this way? Like what prompted that?
Rob Mather: Well, actually, it was more random, perhaps in some ways than that. I wanted to try and get a million people to do something. I was inspired by somebody I met in the US a number of years ago, who when she was 18 raised a million dollars for a cancer charity. And I thought, wow, a million dollars. Thatâs a very large amount of money. And here weâre going back to the 80s. So weâre going back a long time ago when she raised that money. I heard about it a little bit a few years after that. So the idea with World Swim, you mentioned that when we started Toby, was to try and get a million people to do something. My aim was actually to do that for two years: spend a year planning it and then year organizing it. And then I was going to go back and get a proper job. So no, there was no intention of me, thereâs no forethought about how much money can be raised. Itâs just letâs do you know one thing.
Itâs very difficult. If I asked you what youâre going to do in the next year, you probably got a good answer for me. The next three years, next five years, it becomes more challenging. I certainly had no vision that far in advance. And so I guess my aims were just, I want to try and get a million people to swim. I think we can raise some money. It will raise some awareness because wow, a lot of people donât know about this thing called malaria as far as I could tell from talking to a lot of people and doing some reading and so on. The idea was letâs see if we can do something. Iâm really up for doing it and Iâve got some plans as to how Iâd like to do it. But this will be a one off. But it attracted a lot of support and interest. And a number of individuals said you canât stop now nor did I want to because I thought, Hey, thereâs something here. Then we sharpened our focus and our operational elements over the years sort of became much more refined. But broadly, the strategy we started out within those first two years, I guess, has remained the case for the next 17.
Toby Tremlett: Fantastic. Thank you. Yeah, a little bit of a different question here: what is your top advice for new charity entrepreneurs?
Rob Mather: Wow, thatâs a really broad question. And I guess a really good one, because Iâve been asked it before. I guess the first thing I would say, and Iâm echoing some words, or stealing some words from Dustin Moskowitz. He gave a talk at Berkeley, I think, a number of years ago, where his advice to people in setting up a charity, if thatâs what youâre referring to with charity entrepreneurs, is thereâs only one reason for you to do it, and that is because you canât not do it. And I guess that talks to, you know, a very, very high level of interest and a passion in doing something. You donât do it for reasons of, you know, money or control or title or whatever else it is. You do it because you feel really strongly about it because that strength of feeling and commitment will take you through the inevitable tough times that most people experience where something doesnât go right for some reason. So, I think thatâs the first thing: does it sort of come from here, you know, this bit of you in terms of saying I want to do it.
I think thereâs some practical advice I give people when theyâre setting up and, and in the early stages of charities, and I work with quite a lot of charities now in that capacity. The first thing I would say, and itâs not as though one size fits all, but I think Iâve yet to come across a charity who wouldnât have found this helpful for them. Firstly is to raise three years money up front so that you donât find youâve raised a yearâs money six months in youâre thinking, âOh, Iâm going to run out of money in six months time. I need to start focusing on fundraising.â It also acts as a really good acid test as to whether or not youâve got support out there from people. I mean, the other two pieces of advice I often find I give is donât write a business plan. Just sit down with your voice in front of somebody whoâs going to fund you, thatâs your start and just tell them what it is youâre going to do. And if you canât do it in a minute, then something is probably wrong. And bring a software engineer in house. Thatâs the other thing I would say, which maybe most people do these days, but itâs key.
Toby Tremlett: Great. Yeah, thank you. You mentioned earlier that it has been important from the start that youâre going to be collecting information from the people who are distributing the bed nets. How do you collect information from those people and then collect feedback from the end recipients of bed nets if you do, and how does that feedback inform the program?
Rob Mather: We do collect a lot of information from the recipient of bed nets primarily through post distribution monitoring programs. So we distribute nets, but it doesnât stop there. Millions of nets go out to millions of households. We then fund at AMF what we call PDMs (Post Distribution Monitoring) where we go back on a nine monthly basis to one and a half percent of the households that receive nets, randomly selected, to establish net presence, use, and condition. During that process, there is a lot of exchange of information captured within a series of questions, all of which are pretty much focused on can we take actions on the basis of the answers, because yes, you can get sort of anecdotal information that can sort of make you think, but really you want to gather information that is usable in some way.
The post distribution monitoring survey or questionnaire that we ask allows us to understand aspects of use of nets and other household relevant parameters, if you like, but weâre not generally adjusting course dramatically because there is a simple truth that malaria is transmitted by malaria carrying mosquitoes. They generally bite between these hours â 10 oâclock at night and 2 in the morning. If you cover people with a net at that time and even if it has holes and rips and tears, because itâs a long lasting insecticidal net, and mosquitoes donât do an aerobatics maneuver through a hole, they land on the net, pick up insecticide, and that causes knockdown, kills them. Thatâs what works. So Itâs sort of refining information that we gather more than anything else, rather than any sort of fundamental, direction change we might want to embark upon.
Toby Tremlett: Awesome. Thank you. If you were starting AMF today, is there anything that you would be doing differently?
Rob Mather: Iâve thought about that a lot because I find itâs unsatisfactory that my answer to that question is no. I sort of think surely thereâs something I would have done differently. But when I think about the main things that happened when I started AMF, I think Iâd do them all again in that order. You know, thinking about what it is I want to do and why and how Iâm going to do it. And how can I get the financial backing so that Iâve got a number of yearsâ money in the bank, even though Iâve literally done nothing. So thereâs somebody else that sort of shares the belief and the vision, if you like, and then who are the right people I put in place to execute on that and make it happen. I guess it gives evidence to the simplicity of what we did at AMF at the start. And I guess what we still do today. It was just Andrew and I, my colleague Andrew and I for the first 10 years. Andrew and I had worked together in a previous life. He was my head of technology in a previous life, so we knew each other well. We know each other very well now, because we worked together for more than 20 years. Andrew is very, very talented as a software engineer effectively. And so I had a very clear view of what we needed to do. And also through discussions with the previous Swim For Terri - Iâd seen how terrific people were both in the corporate environment and as individual volunteers. I felt there was the possibility of putting significant support in place pro bono that would give us access to supporters because they put their hand up and said, âHey, Iâm going to help.â And additionally, we wouldnât have to spend money that many other charities have to, and your percentage admin rates look really bad. Those key things that we did at the start, Iâd do again.
Toby Tremlett: Great, thank you. I like this one: can you talk us through, as transparently as you can, the costs and benefits of being so transparent?
Rob Mather: Good question. It might be more than two minutes for this one. I think the first thing Iâd say is that you need to come up with the right ideas and sort of processes first of all. Thatâs a sort of starting point. The vision and plan of what you want to do, but youâre going to be transparent about. Thatâs thinking time. Thereâs no cost to that. Then you need to deploy the relevant technology. Thereâs not a lot of cost involved in that. Itâs more of a sort of mindset of how youâre using technology that allows you to gather data, echo out data, [and] share data.
Overall, the process here about what youâre gonna be doing and how youâre going to execute on being transparent, thereâs not much cost in that. I think when you are transparent, you tend to keep things simple because youâre communicating to people so you need to keep things simple. And that allies very closely with efficiency, you tend to become really quite efficient.
The cost, I think, is sort of relatively low in being transparent. Maybe somebody will come up with a cost I havenât thought about but canât think of one big one. What does transparency do in terms of its benefits? Wow, lots. I mean, in some ways Iâm going to echo some of the words I mentioned before it facilitates accountability. No question. It helps you become more efficient because youâre being transparent. I think it drives the use of technology throughout the organization because youâre wanting to share things. Youâve got to use technology to get it quickly and echo it out. I think that ultimately leads when youâre transparent to high levels of confidence in the organization. We never didnât trust, but we donât ask for peopleâs trust. But we do want to develop peopleâs confidence in us, partners, others. And I think, I guess extending, that it encourages support from donors. And all of that allows us to have more impact. So, you know, you can see the key words there in the benefits, costâs pretty low.
Toby Tremlett: Nice. Yeah. I mean, I think thatâs a good answer to a pretty broad question. So, thank you for that. How does the availability of malaria vaccines change AMFâs strategy going forward, if at all?
Rob Mather: It doesnât for the moment [Note that this AMA was recorded on the 19th of December, 2023]. And thatâs because the malaria vaccines that we have at the moment, whilst they are fantastic additions to the toolbox, the tools that we use to fight malaria, I think it is reasonable to say that theyâre relatively modest tools, unbelievably fantastic scientific breakthrough and the scientists that have achieved that are to be congratulated hugely because this is the first time weâve had a vaccine for a parasite. You know, COVID et al is a virus, as we all know. So thatâs been a major breakthrough. I think the comparison I would use when it comes to how useful a vaccine will be so RTSS and M21 are the two vaccines, and they have broadly a 35 to 65 percent efficacy. I may be wrong, but my understanding is that the second vaccine is, may well be heading towards a similar 35 to 50% efficacy and I do apologize to the vaccine scientists if Iâm explaining that incorrectly.
I think itâs useful to look at polio for parameters you want to look at what percentage of the population benefit from the vaccine? Polio 100%. How effective is the vaccine? Polio 100%. How many administrative events with polio? Oneâon a sugar cube or an injection. Are there any cold chain logistics? Polio vaccine? None. If you have to refrigerate, obviously, itâs more expensive. With the malaria vaccines, weâre looking at 35 to 50-ish percent efficacy. Weâre looking at a subset of the population, albeit an important one under fives, but only a subset of that. Three administrative events one month apart, another one a year later and cold chain logistics. So itâs not quite there yet. We hope the scientists, you know, the same scientists or others will build on those success and maybe in the next, Iâm led to believe 7 to 10 years, weâll be talking about a vaccine in slightly different terms. We hope so.
Toby Tremlett: Awesome. I mean, I guess I wonder, how would it change your strategy? Like how closely are you following it? If it [a malaria vaccine] gets rolled out in a specific country, would this make a difference to how you prioritize where your bed nets are distributed?
Rob Mather: We are following it very closely and potentially it would and I think what we have to look at is what is the most effective means of preventing malaria. There are certain things that I think we could do in a vaccine environment that would leverage the capabilities and strengths that we have. I could see there being a future in which AMF might say to donors, weâve done some work over the last year or 18 months or two years where weâve explored operationally how we could contribute to vaccine rollout or distribution and we think we have a role to play. So if people would like to contribute to us, this is what weâre going to do. I could see that happening potentially in the future because I think some of the strengths and experiences that weâve had over the years might put us in a position where we could assist, but we would look at that very closely to see whether or not AMF was the right organization. It might be that there are other organizations that are better placed than us. Weâd have to evaluate that.
Toby Tremlett: Thank you. Another question on your distributions: A forum user called JBentham asks: âI noticed that on your distribution page, you have distributions penciled in for the Democratic Republic of Congo up to 2025. Are these distributions contingent on additional funding? If not, which countries would you be most likely to expand your distributions to in 2024 and 2025 if your funding cap was closed?â
Rob Mather: So anything that we publish is funded. We donât announce a country or a region in a country publicly unless itâs funded because we need to sign a legal agreement with the government and it would not be the right order if we were to make public that we were going to fund nets for a particular area if we hadnât had all the very important operational and data-related elements of a legal agreement fully signed up to. So they are funded.
There are still huge gaps in DRC in the 2024, 2025, and 2026 period. In fact, $145 million worth of gaps, which means that currently the Global Fund, ourselves, and the American government who are all contributing funding to the DRC three-year campaign, because weâre looking at a three-year campaign, itâs not done year by year, youâre talking about a country that is two-thirds the size of Western Europe and it has some very challenging logistics. The lead times are really, really the two or more years in a sense of minimum. So weâve got roughly 62 percent of the population able to be covered and 38 percent not able to be covered and none of the three funding partners have any idea where more funds are going to come from yet.
So weâre very, very worried. And Iâm afraid the numbers will translate into⊠unless we close that gap, and as I say, we have no idea where the funding is going to come from, It already includes some projection of how many, how much will come in over the next sort of couple of years⊠weâre looking at about 30,000 people dying.
So itâs a really critical situation. Other countries where weâve got gaps in funding are Nigeria, Mozambique, Cameroon, Uganda, Chad, South Sudan, Zambia, Guinea and there are others. So weâve got more than a $300 million gap right now that we could allocate, so significant opportunities.
Toby Tremlett: Yeah, I mean, just a follow up on that. Itâs really intense to be working on something where thereâs 30,000 people kind of in the balance on this on just this particular aspect how do you keep the right level of motivation to work on this so that itâs obviously urgent, but it doesnât feel overwhelming? I mean itâs gotten so big, thereâs a lot of people involved in this now.
Rob Mather: Yeah, it got so big, but there are only 13 of us. I mean, itâs still a small team. I guess none of us need any more motivation than I guess those numbers in that one country. And there are at least 10 countries that are like that, that people die and people fall really sick because they donât have something as simple as a bed net. I guess no extra motivation needed.
And, you know, I guess Iâd say two things about myself. One is that I am the worldâs greatest cynic when it comes to charity, Iâm afraid. If I thought I was cynical 19 years ago when I set up AMF, boy, am I cynical now, given what Iâve seen in international aid. There are some really, really good organizations out there. But there are some things that happen that are led by others that are not very good at all, which is why we do what we do in the way we do it. We focus on data. Weâre not perfect. We donât have all the answers. We learn all the time, but weâre very driven by a particular approach that we stick to. I think itâs a very honest one and itâs focused on data. I suppose when you are thinking about hundreds of millions of dollars, itâs natural for all of us to think, well, what, what difference can I make? I mean these numbers are huge. Every $2 matters. You know, people who know AMF will know that refrain. Every $2 broadly buys a net and that net protects two people. And I can tell you that the net is pretty important for the two people who sleep under it. So thereâs no amount that is too small, so to speak, or inconsequential. And we do the best we can. We work as hard as we can within limits. You know, we donât work 20 hours a day, that wouldnât be productive anyway, in the long run. We just try and work efficiently and smart. So Iâm constantly trying to think how we can do things better to, you know, close funding gaps. We get people giving us a hundred dollars and a thousand dollars, and then some people give us much more. Whenever a donation comes in, itâs thrilling because we know what we can do with it.
Toby Tremlett: Thank you and youâre doing great on sticking to the two minutes. Itâs almost exact. So, hereâs a question kind of related to this. Now that you have a bigger team, have you found that comes with more overhead in people management, internal communications and stuff like that? What have been the difficulties of growing the team out from a two-person team for a decade to a massive team of thirteen?
Rob Mather: Bottom line is not much of a difficulty because weâve only gone from two to 13. So weâre still a family in that sense, you know where we [have] strong communication between the vast majority of people most of the time. I mean, not everybody speaks to everybody every day, but weâre remote, we donât have offices, which means that we have the benefit of then being able to choose a talent pool that is all over the world in many cases. Although there are limits because we need time zones to coincide broadly to be efficient. Clearly, there have been [costs] when you grow from 2 to 5 to 7 to 10 to 13, youâre spending more time on recruiting, youâre spending more time on developing people. But those are all pretty pleasurable thingsâyou come across some great people. And what weâre always trying to do is sort of square peg in square hole is finding people whoâve got the background, the characteristics, desire, talents that fit what we try and do. And itâs really rewarding when a number of people have been with AMF for a long time now. Their level of knowledge is very, very high. Their abilities are really strong and weâre bringing on others in the same way who are doing a really good job. So, you know, modest, you know, itâs been a great run over the last five or six years when weâve added people to the team.
Toby Tremlett: Brilliant. Yeah, another question, I guess, about how you run this organization: AMF fundraises separately for its operational costs and for the direct costs of its interventions, as far as I understand. How important has this been for AMFâs growth and its popularity?
Rob Mather: Going back to the points I made about putting three yearsâ money in place, I didnât want to have to worry about raising money and take my eye off the sort of operational ball, if you like. Weâve been very fortunate in having a small group of donors, three effectively, whoâve said, you know, weâll fund the central cost sort of in perpetuity, pretty much. I donât want to take their generosity for granted going forwards because for the money we might need in three years time, we havenât received yet, but you know, that seems to be the way that they view us. I think itâs been very helpful that our overheads as an organization are low. The average of the last five years is our overheads as a percentage of revenue have been about 6 or 7%. Obviously thatâs really quite low partly thatâs because we donât pay for anything other than 11 salaries of the 13 staff, 11 draw salary. We have some expenses when people fly to Africa for obvious reasons. But banking, accounting, legal website, offices, translation, you name it, we donât have it. Itâs zero because we have a lot of pro bono support. We put that in place and thatâs covered. And there are a number of large donors that provide funding that covers the monitoring costs, which are significant. For every 100 million we spend on nets. We spend about seven or eight million on monitoring because we monitor the living daylights out of things we do in the countries in which we operate. Theyâre also covered effectively. Which means that we can say honestly to donors and potential donors, if you give us 10 dollars, we will spend 10 dollars buying nets because everything else is covered. It is incremental. We will buy another 10 dollars worth of nets. And thatâs a really simple message to be able to share with people.
Toby Tremlett: Yeah, thatâs great. I mean, this is another really interesting part of AMFâthe amount of pro bono support that you get. And I mean, presumably volunteer support in your distributions because people obviously have to give out these nets. How does that happen? And how did you arrive at that way of doing things?
Rob Mather: So we fund the nets, and other co-funding partners cover the non-net costs of the distributions. The non-net costs include shipping, in-country transport of nets, registration across millions of households there a lot of health workers visiting households and gathering data), and then the distribution of the nets. These are typically the next step. We fund the nets at roughly $2 a net. The Global Fund or the American government fund the non-net costs, roughly $2 a net. So if weâre putting 20 million worth of nets into Uganda, as weâve just done and are closing out the distribution there, the non-net costs would have been funded by or were funded by the Global Fund. We partner with them. Thereâs no volunteering going on there. There are some volunteer activities that go on in-country, but the work thatâs done in-country is done by people who are paid for PDMs and are on salaries. Itâs just that we donât pay for that.
When thereâs a funding gap⊠Uganda had a $140 million worth of funding needed for the campaign, I think the Global Fund put in $80 million, if Iâm not mistaken, the American government put in $20 million, and there was a gap of $40 million. So we said, weâll come in with $40 million to buy the nets because the case was made in terms of malaria genuine funding gap. In fact, it was $20 million we put in, I beg your pardon. And we bought roughly 10 or 11 million nets, and the non-net costs were funded by others. So that part is a partnership, not volunteer helping in-country. That wouldnât work for a nationwide logistical campaign.
Toby Tremlett: Thanks. I mean, that makes a lot of sense. I was wondering how that part of things works. Thatâs very interesting. Another thing that potentially could change the way you think about this going forward is the rise in insecticide resistance. How has this changed your estimations of the impact of bed nets?
Rob Mather: The impact has not gone down very much. I mean, itâs gone down by, you know, a number of percentage points, perhaps. We havenât done any particular work to say, is it three? Is it five? Is it eight? Is it perhaps as much as 10? What has happened is that new products have been developed. So rather than having, letâs call it a standard net thatâs got a pyrethroid on it, then weâve got nets that have got other active ingredients on it. In one case, a chemical called PBO, piperonyl butoxide, which is a chemical thatâs safe for humans, but it switches off in the mosquito, the mechanism that causes resistance. So, aha! Weâre back in the game when it comes to lower levels of knocking out mosquitoes, not zero, but lower levels because theyâve developed some resistance.
And there are other types of nets that are being developed. When I say types of nets, there are other active ingredients being added to nets. We have a chemical called pyriproxyfen and one called chlorfenapyr. There will not be a test at the end of this hour. But these are chemicals that are added to nets because they act on mosquitoes in a different way and deal with the resistance. Some of these products are showing really promising results. AMF a number of years ago put eight and a half million dollars effectively into a randomized controlled trial to gather the data that would allow us to say whether or not these PBO nets I mentioned worked and if they did in what circumstances and to what degree. That was a very important RCT because it gave us the data, gave all of us the data that said this is how these nets work. And now there are tens of millions of these nets being deployed annually because we all needed the data to support what products we distribute to deal with insecticide resistance.
Toby Tremlett: Awesome. Yeah, thank you. A few of these are questions from Habiba whoâs starting a charity called Spiro to work on TB. I had a few questions, some of the ones about starting the charity are from her. She asks in what situations does it seem like a good idea to start a new initially small charity rather than supporting existing efforts? So, for example, looking from the outside of malaria work in 2005 when you started your charity, one might have felt like this was a huge area with a lot of attention from big global health organizations, and itâd be surprising if a new small organization could be able to bring something different and useful that existing organizations couldnât. So yeah, how did you think about this and how do you think about this question?
Rob Mather: Sometimes there are lots of tankers on the sea and there arenât enough speedboats. And I guess the smaller organizations can do things slightly differently. Theyâre more agile, can do things in a very different way. Maybe a tanker doesnât focus on data, but a speedboat does. I donât want to take the analogy further because Iâll probably drown. But no pun intended. But I suppose itâs whether, in reflecting in the field youâre looking at, is there a need for some activity or intervention or some way of doing things that doesnât currently exist? It is not the case that incumbents have got it right. Often times have moved on and they havenât moved on and itâs really time for a change. And itâs assessing whether there is an organization thatâs really well placed to pivot or whether a new organization is needed. And I guess a new organization often comes with people with that passion I mentioned earlier, desire, and commitment. Maybe they bring in new funding, which can be helpful for the particular causal area. So I think if you assess and thereâs a need for newness, then, hey, go for it. Try it. Because the worst that can happen is you can fail (dot, dot, dot) and learn a huge amount from doing so. Thatâs not really failure. I guess thereâll be pros and cons of any individual situation. But I guess that would be my high-level take.
Toby Tremlett: Great. Thank you. On what frequency do you think about organizational goals and strategy internally? Do you set quarterly goals? Think about big picture strategy annually? How do you think about strategy? When do you course-correct?
Rob Mather: I guess all the time. I think strategy is a fancy word for choices. And you know, I donât think choices are made on a quarterly basis. Choices are made on a daily basis, multiple times a day. And often somebody might look at you, you know, three months on and say, oh, youâve sort of adjusted your strategy a bit here. And you may have done because youâre making slightly different choices, but itâs probably made up of, in most cases, the fact that youâre doing 50 things slightly differently and better. So often itâs not about a major strategic change. I guess you could say that those choices lead to improvements. But weâre constantly thinking about, are we doing this in a way that is maximizing or optimizing our impact? Are we collecting data in the right way? Can we do it without spending so much money? Should we be doing things weâre not doing to give us greater confidence in some of the data in this particular circumstance? Should we be deploying technology in a new way, because now we can scan barcodes of nets or whatever it might be? And, you know, Iâm constantly thinking about that.
At the same time, the flip side of these sorts of thinking and these sorts of choices is risk. And a lot of what I do each day is thinking about risk, de-risking certain situations so things donât happen all the way from people you want in the organization not leaving, people in the organization developing so we maximize their enjoyment and their productivity, to maximizing the percentage of nets that are overheads and beds. So I guess the answer to your question is all the time.
Toby Tremlett: So youâve mentioned the work of the Global Fund. Whatâs your opinion of the other kinds of work that the Global Fund funds for malaria prevention other than, other than bed nets? And would you mind outlining briefly in your answer what else they fund?
Rob Mather: Sure. So I think when it comes to most things in life, the portfolio approach is pretty good. And when it comes to malaria control, there are a portfolio of things that we need to do. I mean, the jigsaw puzzle that is the solution to malaria has probably got about 12 pieces in it: Nets, rapid diagnostic testing kits (RDTKs), indoor residual spraying, ACTs (Artemisinin Controlled Therapy: itâs the drug you take three days of it flushes malaria parasite from your system. Very, very effective), health system strengthening (that runs from making sure that malaria data is recorded accurately, because if itâs not, then we donât know what weâre dealing with, and we donât know if weâre improving, to the training of staff in health centers to deal with blood slide analysis of potentially with malaria.) The Global Fund effectively puts money into all of the aforementioned and more things and itâs really important it does. RDTKs, ACTs, health system strengthening, or HSS as we refer to it, are all really important. You canât not do any of these things. Sometimes in a country, you get to the point where health system strengthening has really suffered because thereâs just not been enough money and there have been other priorities and urgencies, if you like, and it gets to the point where you sort of got to go, âWhoa, whoa, whoa, time out. Weâve got to put money into health system strengthening because unless we do that, things are going to start to fall apart and undermine aspects of these fundamental programs.â
Iâm a big fan of money going into all of these things. I know that there are evaluators that look at AMF and others and look at the net program, but you canât just do a net program. Itâs really important that itâs funded well. But you canât do that and have other things at really low levels. You need the engine in the car, funding nets, but you also need the wheels and a steering wheel and some other things. Probably a bad analogy, but there we go.
Toby Tremlett: No, I think that makes sense. And thatâs good to hear because I think often when you hear about AMF as an example in effective altruism, itâs not as part of an integrated picture of how weâre tackling malaria. Itâs as an example of exactly what AMF does. Iâve mostly heard about bed nets, so itâs great to hear that thereâs so much else going on.
Rob Mather: And much of that jigsaw puzzle, Toby, sorry to interrupt, is that SMC, Seasonal Malaria Chemoprevention, is now a really important part of the toolbox that we have. But again, if we had 12 pieces to the jigsaw puzzle before, that is the solution to malaria, itâs now 13.
Toby Tremlett: Yeah, that makes sense. So, someone mentioned that AMF has leveraged corporate support and partnerships, perhaps more than other charities do. Does that seem true to you? And if so, is it something that you think lean nonprofits should be doing more?
Rob Mather: I think the simple answer is yes, that we do leverage it more than others. And I guess the second answer to your second question is yes. I think weâre within our two minutes, so I should probably expand on that. Itâs been really humbling over the years to go to people to phone people up and say, âWho do I speak to in your industry whoâd be willing to do this thing pro bono for free because I donât think you need a $5 more than a couple of kids in Africa need a bed net?â I can honestly say that in 19 years, when Iâve asked that question, Iâve obviously chosen the person Iâve spoken to with intent and carefully, I know my ground and, and so on. So thereâs some preparation involved. But in 19 years, Iâve never, ever had any other answer to that question in any other, in any area in which Iâve asked it than the one word answer I get, and that is âme.â And I go, âReally?â And they say, âYeah, weâll help you.â And I think what that shows is that there are lots of people out there who are willing to help. Obviously, there is a strategy behind asking and what you ask for and how you ask for it, which I probably donât have time in two minutes to go into. But, itâs not particularly rocket science. Itâs largely rooted in common sense. Certainly, weâve experienced terrific support. I know other charities have, some of whom I now work with, but I think there are very few charities, I would argue, that probably donât have a number of areas in which they could reduce costs and improve, through collaboration, some of the things they do by engaging pro bono support, because there are lots of people that are willing to help.
Toby Tremlett: Yeah, thatâs great to hear that itâs been so successful. I know that it might take a lot longer to express this, but do you have any tips for that [getting pro bono help as a charity]? Why do you think thatâs been the case? Is it based on how you pick these people? Like, is it networking? Whatâs going into that success?
Rob Mather: Itâs not networking, actually. I chose not to network in any stage of setting up AMF. I mean, I probably had a Rolodex that I could have dipped into, but I really didnât want to because I didnât want people to say, âOh, whatâs Rob up to now? Yes, weâll support him.â I wanted it to be a somebody who, you know, did not know me and looked at the, you know, the merits of what I was suggesting. And if they were to say, âYeah, look, this is really interesting. Weâre happy to back this,â then I think you have a better indication, youâre onto something. I think itâs picking areas of support where the ask youâre going to make of the people youâre going to approach is not such that theyâre going to go, âWow, thatâs a lot.â Itâs a relatively modest contribution, and it might be interesting in year one, but then because of that contribution and the work and the heavy lifting thatâs done, the support youâre effectively going to ask of them is going to be much reduced in future years. It doesnât hit that screen of people saying, âWow, weâre really spending a lot of money effectively or foregoing a lot of revenue in providing this support.â I think you develop some experience of who to ask and sometimes when to ask them at what stage in your progress is right to ask them. Those factors have all been part of when I have approached people. In the first couple of years of establishing AMF, there was a lot of thought that went into that. But what I described to people was just a genuine situation and said, âWould you be in a position to help?â There was no cleverness. It was really just going to somebody and saying, âThis is where we need help. Will you?â And we had terrific responses.
Toby Tremlett: Right. Yeah. Thank you. Finally, what does the relationship between AMF and the effective altruism community look like from your side?
Rob Mather: Itâs a pretty warm one. I mean, certainly my sentiment towards the EA community is pretty warm because significant funds have flowed to us from effective altruists. Theyâve also flowed to us from many others, some of whom have not heard of EA, or what itâs about. But when I first spoke with Peter Singer many years ago and with Toby Ord and with Will MacAskill and others, there was clearly a sort of alignment of thinking, of how we saw the world in some ways, which I guess in a very uncomplicated way is, there are a lot of opportunities to help people in a pretty fundamental way.
And so personally, I have that view. And I think a lot of people within the EA Movement have a fundamental generosity because it is still remarkable to me the money that is donated to us by some people in terms of a percentage of what they earn. So what we try and do from our side is to be as communicative as possible, both in terms of being really open and transparent with our work and data that surrounds it. And when people approach us from within the EA community and say, âHey, weâve got some questions, or could you appear here and could you tell us about how you do something because we want to find out more?â So itâs a pretty warm one for which weâre very grateful.
Toby Tremlett: Great. Well, this has been great. I feel like Iâve learned a lot. Itâs just some really interesting questions on the AMA. And thank you so much again for your time.
Rob Mather: Pleasure. Thanks a lot, Toby.
Thanks so much for doing this and for sharing! I found his comments on the portofolio of the Global Fundâs malaria work to be particularly interesting :)
Thank you!
And me too- I think I say this in the recording but I hadnât really thought of malaria nets in context before.