GiveWell Top Charities Explained: Malaria Consortium

Link post

[This is the first post in a brief se­ries ex­plain­ing the cur­rent GiveWell top char­i­ties. You can get all the in­for­ma­tion in this post on GiveWell’s web­site, but my blog post is both shorter and less bor­ing.]

The Malaria Con­sor­tium is a brand-new GiveWell top char­ity. They do sea­sonal malaria chemo­pre­ven­tion– that is, they give chil­dren un­der six pre­ven­ta­tive anti-malar­ial drugs, so that the chil­dren don’t get malaria and don’t die. And their cost-per-life-saved-equiv­a­lent is..

…drum­roll please…


Okay, you shouldn’t take cost-effec­tive­ness anal­y­sis liter­ally. The GiveWell cost-effec­tive­ness analy­ses are com­pre­hen­sive, but there are a lot of fac­tors that aren’t in­cluded, and there’s always a bunch of un­cer­tainty that dis­ap­pears with an overly pre­cise num­ber like “$2,292”. At the very least, you should go to that spread­sheet, click on the tab that says “moral weights,” and put in your own num­bers, be­cause oth­er­wise you’re say­ing “my eth­i­cal be­liefs are ex­actly equiv­a­lent to the av­er­age of what all GiveWell em­ploy­ees be­lieve about ethics,” which is a stupid way to do ethics.

But nev­er­the­less it is true that the cost-per-life-saved num­bers for the Malaria Con­sor­tium are stupidly cheap.

If you’re a char­ity nerd like me, you’ve got­ten a bit used to the situ­a­tion with global poverty char­i­ties. The top char­ity is always bed­nets, and the cost-per-life-saved-equiv­a­lent is always about the same– some­times it’s $3,500, some­times it’s $4,000.

And this year not only do we have a new top char­ity, the cost-per-life-saved equiv­a­lent has dropped more than a thou­sand fuck­ing dol­lars.

Like, what the fuck?

The Cochrane Col­lab­o­ra­tion sum­ma­rizes the effects of sea­sonal malaria chemo­pre­ven­tion as fol­lows:

[Sea­sonal malaria chemo­pre­ven­tion] pre­vents ap­prox­i­mately three quar­ters of all clini­cal malaria epi­sodes (rate ra­tio 0.26; 95% CI 0.17 to 0.38; 9321 par­ti­ci­pants, six tri­als, high qual­ity ev­i­dence), and a similar pro­por­tion of se­vere malaria epi­sodes (rate ra­tio 0.27, 95% CI 0.10 to 0.76; 5964 par­ti­ci­pants, two tri­als, high qual­ity ev­i­dence). Th­ese effects re­main pre­sent even where in­sec­ti­cide treated net (ITN) us­age is high (two tri­als, 5964 par­ti­ci­pants, high qual­ity ev­i­dence).

This is the Cochrane Col­lab­o­ra­tion we’re talk­ing about here. Th­ese are the peo­ple who think there’s not ad­e­quate ev­i­dence that floss­ing makes your gums bet­ter. When Cochrane says “not only does this work, it pre­vents three quar­ters of all malaria epi­sodes,” you sit up and take no­tice.

Un­for­tu­nately, it’s not clear that sea­sonal malaria chemo­pre­ven­tion re­duces over­all mor­tal­ity. Not that many peo­ple die of malaria ev­ery year, so you need to have a huge study to be able to de­tect changes in over­all mor­tal­ity. One study, Cisse (2016), was sup­posed to be big enough to de­tect changes in mor­tal­ity, but fewer chil­dren died than was ex­pected, which prob­a­bly makes the sci­en­tists in­volved feel like hor­rible peo­ple ev­ery time they com­plain about it.

GiveWell thinks the Malaria Con­sor­tium could pro­duc­tively use way more money than they’ll ac­tu­ally get: their room for more fund­ing is $65.7 mil­lion.

So this is great, right? Time to give away all our money to the Malaria Con­sor­tium!

Well, there’s one lit­tle prob­lem and one big prob­lem.

The lit­tle prob­lem is that the sur­veys to find out how many chil­dren get sea­sonal malaria chemo­pre­ven­tion suffer from some se­vere method­olog­i­cal limi­ta­tions: for ex­am­ple, the villages of­ten aren’t ran­domly cho­sen, and care­givers of­ten say they’ve given a dose when they didn’t mark the card they were sup­posed to mark when they gave a dose. It’s true that the sur­veys some­times show re­ally low rates of chil­dren get­ting treated, which would be weird if the Malaria Con­sor­tium were de­liber­ately giv­ing GiveWell mis­lead­ing re­sults. But even if the Malaria Con­sor­tium isn’t be­ing mis­lead­ing it might be hard to know how well they’re im­ple­ment­ing the pro­gram.

The big prob­lem is drug re­sis­tance.

Sea­sonal malaria chemo­pre­ven­tion uses two drugs: sul­fa­dox­ine–pyrimethamine (SP) and amodi­aquine (AQ). The good news is that both drugs are ba­si­cally only used for malaria, so we don’t have to worry about any other nasty bugs de­vel­op­ing re­sis­tance to them. The bad news is that they’re both very com­monly used, effec­tive, and cheap treat­ments for malaria, and if you give them to ev­ery­one un­der the age of five, it makes it much more likely that malaria will evolve re­sis­tance to them.

The ex­perts GiveWell has talked to ex­pect that sea­sonal malaria chemo­pre­ven­tion will not re­sult in malaria evolv­ing drug re­sis­tance to SP and AQ within the next five to ten years. But five to ten years is not a very long time. We’re prob­a­bly still go­ing to have malaria in the next five to ten years. It would suck if malaria were harder to treat.

The Malaria Con­sor­tium is do­ing a study right now of how fast re­sis­tance seems to be evolv­ing, so we might have more in­for­ma­tion and bet­ter es­ti­mates in the fu­ture. But right now drug re­sis­tance is some­thing I at least am re­ally wor­ried about.

The Malaria Con­sor­tium needs $39.4 mil­lion dol­lars over the next three years.

Why might you donate to the Malaria Con­sor­tium?

  • You care a lot about sav­ing the lives of chil­dren un­der six.

  • You want to donate to a pro­gram that definitely works and is cost-effec­tive, even if it might have other nega­tive im­pacts.

  • You’re op­ti­mistic about mak­ing sig­nifi­cant progress in erad­i­cat­ing malaria in the next few decades, or about malaria not de­vel­op­ing drug re­sis­tance.

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