The AIDS/​malaria puzzle: bleg

A few months ago, I posted to Face­book a puz­zle about the differ­ence in fund­ing for AIDS and malaria. Here is the puz­zle:

  1. DAH spend­ing for AIDS is much more than malaria: Devel­op­ment as­sis­tance for health (DAH) num­bers from the In­sti­tute for Health Met­rics and Eval­u­a­tion (IHME) show that de­vel­op­ment as­sis­tance spend­ing on AIDS sig­nifi­cantly ex­ceeds spend­ing on malaria. For in­stance, if you click on the link and switch to “Trends” and “Health fo­cus” you’ll see that AIDS DAH spend­ing in 2016 was es­ti­mated as $9.5 billion whereas malaria DAH spend­ing was es­ti­mated as $2.5 billion. Most of this differ­ence comes from gov­ern­ment spend­ing (break­down by source also at the link). In fact, to­tal an­nual spend­ing by the US gov­ern­ment on HIV/​AIDS is around $33 billion, more than the Na­tional In­sti­tutes of Health (NIH) bud­get, though most of it is do­mes­tic spend­ing.

  2. Effec­tive al­tru­ists and al­lied groups have fo­cused much more on malaria than AIDS through­out their his­tory: Malaria has been iden­ti­fied by GiveWell as a promis­ing area since 2006, and the Against Malaria Foun­da­tion has been a GiveWell top-rated char­ity since 2011, ex­cept­ing one year. Giv­ing What We Can has also recom­mended the Against Malaria Foun­da­tion since be­fore it be­came a GiveWell top char­ity, and it has also been the poster boy of effec­tive al­tru­ism for fundrais­ing groups like The Life You Can Save and Char­ity Science. In con­trast, HIV/​AIDS hasn’t been a ma­jor fo­cus, with GiveWell get­ting around to re­view­ing a HIV/​AIDS-re­lated in­ter­ven­tion only in 2017.

  3. Crude es­ti­mates of the toll of the two dis­eases paints a pic­ture of fairly com­pa­rable im­pact: Malaria af­fects five or more times as many peo­ple as AIDS. But on the other hand, once you get AIDS, you are stuck with it, whereas you can usu­ally re­cover from malaria in a few weeks. On the third hand, the agony per unit time of hav­ing AIDS is lower than that of malaria. The an­nual death toll of AIDS is about dou­ble that of malaria (a mil­lion ver­sus 400,000), though es­ti­mates for both have huge er­ror bars.

In­ter­est­ingly the Gates Foun­da­tion, which can be con­sid­ered in­ter­me­di­ate be­tween a gov­ern­ment donor and an “effec­tive al­tru­ist”, has an AIDS/​malaria spend­ing split in be­tween the two: it spends roughly equally on the two; see break­down of funds for grants in de­vel­op­ing coun­tries.

The ten­sion be­tween (1) and (2) is an in­ter­est­ing puz­zle. It could be that:

  • DAH spenders are wrong about their fo­cus on AIDS, and in an ideal world would be di­rect­ing more re­sources to­ward malaria.

  • Effec­tive al­tru­ists are wrong about their fo­cus on malaria, and in an ideal world would be di­rect­ing more re­sources to­ward HIV/​AIDS.

  • They are both right “in their own way”; HIV/​AIDS spend­ing is the right call to make for DAH spenders whereas malaria spend­ing is the right thing to do for effec­tive al­tru­ists. While the most con­cili­a­tory to all sides, this also de­mands the most ex­pla­na­tion, since rel­a­tivism challenges some of the im­plicit and ex­plicit ideas of effec­tive al­tru­ism.

I have ex­plored some more spe­cific hy­pothe­ses in a com­ment on my Face­book post, which I shall not re­peat here for brevity.

I’ve already spent a fair amount of effort col­lat­ing the his­tory of malaria, in­clud­ing fund­ing a bunch of malaria-re­lated timelines such as timeline of malaria, timeline of mosquito net dis­tri­bu­tion, timeline of the Global Fund, timeline of malaria vac­cine, timeline of Against Malaria Foun­da­tion, and timeline of malaria in 2014, 2015, 2016, and 2017. I in­tend to spend similar effort on HIV/​AIDS, and re­turn to the puz­zle af­ter that. How­ever, I’m cu­ri­ous about any thoughts read­ers here have on the puz­zle, in­clud­ing whether you find it in­ter­est­ing, po­ten­tial re­s­olu­tions or di­rec­tions to ex­plore, or re­fu­ta­tions of the premises of the puz­zle.

Thanks to Se­bas­tian Sanchez and Issa Rice for work­ing on the linked timelines. Thanks to Howie Lem­pel for com­ment­ing with thoughts on my origi­nal Face­book post. And thanks to IHME for col­lat­ing Devel­op­ment As­sis­tance for Health (DAH) spend­ing, look­ing at which in­spired this post.