The GiveWell Top Charities are part of the Open Philanthropy Project’s optimal philanthropic portfolio, when only direct impact is considered.
There’s not enough money to cover the whole thing.
These are highly unlikely to both be true. Global poverty cannot plausibly be an unfillable money pit at GiveWell’s current cost-per-life-saved numbers. At least one of these three things must be true:
GiveWell’s cost per life saved numbers are wrong and should be changed.
The top charities’ interventions will reach substantially diminishing returns long before they’ve managed to massively scale up.
A few billion dollars can totally wipe out major categories of disease in the developing world.
I don’t think I understand the trilemma you presented here.
As a sanity check, under-5 mortality is about 6 million worldwide. Assuming that more than 2⁄3 is preventable (which I think is a reasonable assumption if you compare with developed world numbers on under-5 mortality), this means there are 4 million+ preventable deaths (and corresponding suffering) per year. At $10000 to prevent a death, this is already way more money than Open Phil has in a few months. At $3500 to prevent a death, this is still more money than Open Phil has in even a single year.
We would expect the numbers to also be much larger if we’re not prioritizing just deaths, but also prevention of suffering.
GBD 2015 estimates that communicable, maternal, neonatal, and nutritional deaths worldwide amount to about 10 million in 2015. And they are declining at a rate of about 20% per decade. 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.
That’s an extreme upper bound. It’s not limited to the developing world, or to especially tractable problems. You almost certainly can’t scale up that high at current costs—after all, the GiveWell top charities are supposed to be the ones pursuing the most important low-hanging fruit, tractable interventions for important but straightforward problems. But then, how high can you scale up at similar cost-effectiveness numbers? Can you do a single disease? For one continent? One region? One country? Now, we’re getting to magnitudes that may fall well within Good Ventures’s ability to fund the whole thing. (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.) 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? Similarly, nutritional interventions such as food fortification tend to be permanent. There’s a one-time cost, and then it’s standard practice.
GBD 2015 estimates that there are only about 850,000 deaths due to neglected tropical diseases each year, worldwide. At $5,000 per life saved, that’s about $4.2 billion to wipe out the whole category. Even less if you focus on one continent, or one region, or one country. To name one example, Haiti is a poor island with 0.1% of the world’s population; can we wipe out neglected tropical diseases for $4.2 million there? $40 million?
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 I understand the trilemma you presented here.
As a sanity check, under-5 mortality is about 6 million worldwide. Assuming that more than 2⁄3 is preventable (which I think is a reasonable assumption if you compare with developed world numbers on under-5 mortality), this means there are 4 million+ preventable deaths (and corresponding suffering) per year. At $10000 to prevent a death, this is already way more money than Open Phil has in a few months. At $3500 to prevent a death, this is still more money than Open Phil has in even a single year.
We would expect the numbers to also be much larger if we’re not prioritizing just deaths, but also prevention of suffering.
GBD 2015 estimates that communicable, maternal, neonatal, and nutritional deaths worldwide amount to about 10 million in 2015. And they are declining at a rate of about 20% per decade. 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.
That’s an extreme upper bound. It’s not limited to the developing world, or to especially tractable problems. You almost certainly can’t scale up that high at current costs—after all, the GiveWell top charities are supposed to be the ones pursuing the most important low-hanging fruit, tractable interventions for important but straightforward problems. But then, how high can you scale up at similar cost-effectiveness numbers? Can you do a single disease? For one continent? One region? One country? Now, we’re getting to magnitudes that may fall well within Good Ventures’s ability to fund the whole thing. (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.) 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? Similarly, nutritional interventions such as food fortification tend to be permanent. There’s a one-time cost, and then it’s standard practice.
GBD 2015 estimates that there are only about 850,000 deaths due to neglected tropical diseases each year, worldwide. At $5,000 per life saved, that’s about $4.2 billion to wipe out the whole category. Even less if you focus on one continent, or one region, or one country. To name one example, Haiti is a poor island with 0.1% of the world’s population; can we wipe out neglected tropical diseases for $4.2 million there? $40 million?
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.