I don’t think linear giving opportunities closely analogous to bednets will take $10BB without diminishing returns (although you might be able to beat that with R&D, advocacy, gene drives, and other leveraged strategies for a longer period). But I think this is a flawed argument.
If at current cost-effectiveness levels, top charities could scale up to solve that whole problem, then if we assume a cost of $5,000 per life saved, the whole thing would cost $50 billion/yr. That’s more than Good Ventures has on hand—but it’s not an order of magnitude more. It’s not more than Good Ventures and its donors and the Gates foundation ($40 billion) and Warren Buffett’s planned gifts to the Gates Foundation add up to—and all of those parties seem to be interested in this program area.
The original text strongly suggested a one-time cost, not a recurring annual cost. When you have diminishing returns in a single year (especially as programs are scaled up; BMGF has ramped up its spending over time), the fact that they don’t spend everything in a firehose in a single year is far from shocking (note BMGF has spent a lot on US education too, it’s not a pure global poverty focus although that is its main agenda).
The Institute of Health Metrics and Evaluation estimated that between 2000 and 2014 the $73.6 billion spent on child health by donors (including both private and public) averted the death of 14 million infants and children. This is in addition to the $133 billion spent on child health by low- and middle-income country governments, which is estimated to have averted the deaths of 20 million children.
The annual figure for this is ~$14 billion (and not all spent where the evidence is best, including corruption, etc).
Gates Foundation spending is several billion dollars per year spread across a number of areas.
Total spending in these areas is not so large that a billion dollars a year is a drop in the bucket, and theses diseases have been massively checked or reduced (e.g. malaria, vaccinations, slowing HIV infections, smallpox eradication, salt iodization, etc).
And we haven’t explicitly talked about possible leverage from R&D and advocacy in poverty.
Starting with a small area where you can show clear gains is not a new idea—it’s the intuition behind Jeffrey Sachs’s idea of millennium villages
Those were criticized at the time for spending so much on the same people, including less well-supported interventions and over diminishing returns, rather than doing more cost-effective interventions across a larger number of people. Local effectiveness of medical interventions is tested in clinical trials.
And remember that once you wipe out a communicable disease, it’s much cheaper to keep it away; when’s the last time people were getting smallpox?
Smallpox was a disease found only in humans with a highly effective vaccine. Such diseases are regularly locally extirpated, although getting universal coverage around the world to the last holdout regions (civil war, conspiracy theories about the vaccinations) can be very hard, as in polio eradication, and infectious diseases can quickly recolonize afterwards (malaria rebounded from the 60s failed eradication effort in places without continuing high quality prevention). But polio eradication is close and is a priority of e.g. Gates Foundation funding. It’s also quite expensive, more than $10 billion so far. For harder to control diseases without vaccines like malaria, even moreso (and you couldn’t just spend more in a big bang one year and be sure you haven’t missed a spot).
This seems like evidence for a combination of the second and third possibilities in the trilemma. Either GiveWell should expect to be able to point to empirical evidence of dramatic results soon (if not already), or it should expect to reach substantially diminishing returns, or both.
I agree that there are lots of practical reasons why you can’t just firehose this stuff—that’s part of the diminishing returns story!
I could imagine a scenario that slips in between 2 and 3, like you don’t hit substantially diminishing returns on malaria until the last 1% of incidence, but is there reason to think that’s the case?
I could imagine a scenario that slips in between 2 and 3, like you don’t hit substantially diminishing returns on malaria until the last 1% of incidence, but is there reason to think that’s the case?
I suggest reading about the Gates malaria eradication plans, including the barriers to that which lead Gates to think ITINs alone can’t achieve eradication.
I don’t think linear giving opportunities closely analogous to bednets will take $10BB without diminishing returns (although you might be able to beat that with R&D, advocacy, gene drives, and other leveraged strategies for a longer period). But I think this is a flawed argument.
The original text strongly suggested a one-time cost, not a recurring annual cost. When you have diminishing returns in a single year (especially as programs are scaled up; BMGF has ramped up its spending over time), the fact that they don’t spend everything in a firehose in a single year is far from shocking (note BMGF has spent a lot on US education too, it’s not a pure global poverty focus although that is its main agenda).
GWWC’s FAQ claims:
The annual figure for this is ~$14 billion (and not all spent where the evidence is best, including corruption, etc).
Gates Foundation spending is several billion dollars per year spread across a number of areas.
Total spending in these areas is not so large that a billion dollars a year is a drop in the bucket, and theses diseases have been massively checked or reduced (e.g. malaria, vaccinations, slowing HIV infections, smallpox eradication, salt iodization, etc).
And we haven’t explicitly talked about possible leverage from R&D and advocacy in poverty.
Those were criticized at the time for spending so much on the same people, including less well-supported interventions and over diminishing returns, rather than doing more cost-effective interventions across a larger number of people. Local effectiveness of medical interventions is tested in clinical trials.
Smallpox was a disease found only in humans with a highly effective vaccine. Such diseases are regularly locally extirpated, although getting universal coverage around the world to the last holdout regions (civil war, conspiracy theories about the vaccinations) can be very hard, as in polio eradication, and infectious diseases can quickly recolonize afterwards (malaria rebounded from the 60s failed eradication effort in places without continuing high quality prevention). But polio eradication is close and is a priority of e.g. Gates Foundation funding. It’s also quite expensive, more than $10 billion so far. For harder to control diseases without vaccines like malaria, even moreso (and you couldn’t just spend more in a big bang one year and be sure you haven’t missed a spot).
This seems like evidence for a combination of the second and third possibilities in the trilemma. Either GiveWell should expect to be able to point to empirical evidence of dramatic results soon (if not already), or it should expect to reach substantially diminishing returns, or both.
I agree that there are lots of practical reasons why you can’t just firehose this stuff—that’s part of the diminishing returns story!
I could imagine a scenario that slips in between 2 and 3, like you don’t hit substantially diminishing returns on malaria until the last 1% of incidence, but is there reason to think that’s the case?
I suggest reading about the Gates malaria eradication plans, including the barriers to that which lead Gates to think ITINs alone can’t achieve eradication.