I think the post is more fundamentally flawed; there is a substantial funding gap under Benjamin’s assumptions, even if we were to ignore GiveDirectly and other cause areas, and even if we were unwilling to save a life for any more than $5,000.
According to the 2017 Global Burden of Disease report, around 10 million people die per year, globally, of “Communicable, maternal, neonatal, and nutritional diseases.”* This is roughly the category that the low cost-per-life-saved interventions target. If we assume that all of this is treatable at current cost per life saved numbers—the most generous possible assumption for the claim that there’s a funding gap—then at $5,000 per life saved (substantially higher than GiveWell’s current estimates), that would cost about $50 Billion to avert.
This is already well within the capacity of funds available to the Gates Foundation alone, and the Open Philanthropy Project / GiveWell is the main advisor of another multi-billion-dollar foundation, Good Ventures. The true number is almost certainly much smaller because many communicable, maternal, neonatal, and nutritional diseases do not admit of the kinds of cheap mass-administered cures that justify current cost-effectiveness numbers.
Of course, that’s an annual number, not a total number. But if we think that there is a present, rather than a future, funding gap of that size, that would have to mean that it’s within the power of the Gates Foundation alone to wipe out all fatal communicable diseases immediately, a couple times over—in which case the progress really would be permanent, or at least quite lasting. And infections are the major target of current mass-market donor recommendations.
The Open Philanthropy Project started out with $8.3 billion in 2011, and presumably has less now. The Gates Foundation has an endowment of $50.7 billion as of 2017. They wouldn’t be able to sustain $50 billion of annual donations for very long. As such, I think the first and second paragraphs are essentially invalid.
It sounds dubious that we could wipe out communicable diseases in a few years and have that be permanent without any further investment. The 2017 Global Burden of Disease lists some communicable diseases as follows: HIV/AIDS, syphilis, chlamydia, gonococcal infection, tuberculosis, other respiratory infections, diarrheal disease, typhoid, salmonella, malaria, schistosomiasis, dengue, rabies, other neglected tropical diseases, ebola, zika, meningitis, measles, hepatitis, tetanus, and so on.
My understanding is that rather few of these have been permanently eliminated, even in high income countries. Distributing condoms and PrEP for a few years isn’t going to permanently eliminate HIV. Bed nets and seasonal chemoprevention aren’t going to eliminate malaria. Measles needs ongoing vaccinations. Etc.
There are of course more permanent solutions that we can use, but these are probably much more expensive and it’s unclear whether the two foundations would be able to fully fund them. In the late 1940s, the US substantially reduced malaria by draining swamps and spraying mosquito spray.¹ There’s gene drives of course, but we probably need more research at this point before we can safely try to eliminate mosquitoes with that. Ending worms, diarrheal disease, or typhoid would probably require incredible improvements to the water supply. Still, HIV and respiratory infections would probably not be possible to eliminate without substantial improvements in medicine.
Also, the Gates Foundation is not particularly EA, and we should not expect it to put all its money into global health. (Nor would we assume Open Phil to do so, because it also cares about other cause areas.) In any case, even if they could fill the gap, that’s not a relevant counterfactual unless they would fill the gap.
All of the above is using Benjamin’s charitable, optimistic assumption that we can save a life for $5,000 up to $50 billion per year. If we consider just the room for more funding of all the top GiveWell charities better than GiveDirectly, is that low enough that Open Phil and the Gates Foundation can completely fill it? Possibly, in which case I will defer to the argument Jeff Kaufman’s post.
While I agree with a lot of the critiques in this comment, I do think it isn’t really engaging with the core point of Ben’s post, which I do think is actually an interesting one.
The question that Ben is trying to answer is “how large is the funding gap for interventions that can save lives for around $5000?”. And for that, the question is not “how much money would it take to eliminate all communicable diseases?”, but instead is the question “how much money do we have to spend until the price of saving a life via preventing communicable diseases becomes significantly higher than $5k?”. The answer to the second question is upper-bounded by the first question, which is why Ben is trying to answer that one, but that only serves to estimate the $5k/life funding gap.
And I think he does have a reasonable point there, in that I think the funding gap on interventions at that level of cost-effectiveness does seem to me to be much lower than the available funding in the space, making the impact of a counterfactual donation likely a lot lower than that (though the game theory here is complicated and counterfactuals are a bit hard to evaluate, making this a non-obvious point).
I think, though I have very high uncertainty bounds around all of this, is that the true number is closer to something in the space of $20k-$30k in terms of donations that would have a counterfactual impact of saving a life. I don’t think this really invalidates a lot of the core EA principles as Ben seems to think it implies, but it does make me unhappy with some of the marketing around EA health interventions.
The 8.3 billion should have grown since 2011. Openphil’s grants have not even totalled 800 million yet and that is the amount that the fund should have grown *per year* in the interim.
I think the post is more fundamentally flawed; there is a substantial funding gap under Benjamin’s assumptions, even if we were to ignore GiveDirectly and other cause areas, and even if we were unwilling to save a life for any more than $5,000.
The Open Philanthropy Project started out with $8.3 billion in 2011, and presumably has less now. The Gates Foundation has an endowment of $50.7 billion as of 2017. They wouldn’t be able to sustain $50 billion of annual donations for very long. As such, I think the first and second paragraphs are essentially invalid.
It sounds dubious that we could wipe out communicable diseases in a few years and have that be permanent without any further investment. The 2017 Global Burden of Disease lists some communicable diseases as follows: HIV/AIDS, syphilis, chlamydia, gonococcal infection, tuberculosis, other respiratory infections, diarrheal disease, typhoid, salmonella, malaria, schistosomiasis, dengue, rabies, other neglected tropical diseases, ebola, zika, meningitis, measles, hepatitis, tetanus, and so on.
My understanding is that rather few of these have been permanently eliminated, even in high income countries. Distributing condoms and PrEP for a few years isn’t going to permanently eliminate HIV. Bed nets and seasonal chemoprevention aren’t going to eliminate malaria. Measles needs ongoing vaccinations. Etc.
There are of course more permanent solutions that we can use, but these are probably much more expensive and it’s unclear whether the two foundations would be able to fully fund them. In the late 1940s, the US substantially reduced malaria by draining swamps and spraying mosquito spray.¹ There’s gene drives of course, but we probably need more research at this point before we can safely try to eliminate mosquitoes with that. Ending worms, diarrheal disease, or typhoid would probably require incredible improvements to the water supply. Still, HIV and respiratory infections would probably not be possible to eliminate without substantial improvements in medicine.
Also, the Gates Foundation is not particularly EA, and we should not expect it to put all its money into global health. (Nor would we assume Open Phil to do so, because it also cares about other cause areas.) In any case, even if they could fill the gap, that’s not a relevant counterfactual unless they would fill the gap.
All of the above is using Benjamin’s charitable, optimistic assumption that we can save a life for $5,000 up to $50 billion per year. If we consider just the room for more funding of all the top GiveWell charities better than GiveDirectly, is that low enough that Open Phil and the Gates Foundation can completely fill it? Possibly, in which case I will defer to the argument Jeff Kaufman’s post.
While I agree with a lot of the critiques in this comment, I do think it isn’t really engaging with the core point of Ben’s post, which I do think is actually an interesting one.
The question that Ben is trying to answer is “how large is the funding gap for interventions that can save lives for around $5000?”. And for that, the question is not “how much money would it take to eliminate all communicable diseases?”, but instead is the question “how much money do we have to spend until the price of saving a life via preventing communicable diseases becomes significantly higher than $5k?”. The answer to the second question is upper-bounded by the first question, which is why Ben is trying to answer that one, but that only serves to estimate the $5k/life funding gap.
And I think he does have a reasonable point there, in that I think the funding gap on interventions at that level of cost-effectiveness does seem to me to be much lower than the available funding in the space, making the impact of a counterfactual donation likely a lot lower than that (though the game theory here is complicated and counterfactuals are a bit hard to evaluate, making this a non-obvious point).
I think, though I have very high uncertainty bounds around all of this, is that the true number is closer to something in the space of $20k-$30k in terms of donations that would have a counterfactual impact of saving a life. I don’t think this really invalidates a lot of the core EA principles as Ben seems to think it implies, but it does make me unhappy with some of the marketing around EA health interventions.
The 8.3 billion should have grown since 2011. Openphil’s grants have not even totalled 800 million yet and that is the amount that the fund should have grown *per year* in the interim.
This piece does a good job at making this point: https://www.givingwhatwecan.org/post/2015/06/cost-fighting-malaria-malnutrition-neglected-tropical-diseases-and-hivaids-and/