Hi, Jesper,
Thank you for this post, and apologies that it took a while for us to respond!
We agree that more public information clarifying the value of donating to these large charities would be helpful. One thing that has changed about GiveWell since the 2011 blog post is that we now have a much larger staff and have gained more research experience, so we have more capacity to investigate the complicated questions that working with very large charities can bring up. We’re now more open to investigating opportunities within “mega-charities” than we were previously.
One factor that we consider whenever we make a grant is funging, or the possibility that a grant from GiveWell will cause other actors to allocate their funding differently. If a program gets money from GiveWell, another funder that would have supported that program might then decide to fund a different program that’s less cost-effective, reducing the impact of our funding. Or, the organization that runs the program could decide to move some of its unrestricted funding to another of its programs that’s less impactful. We would want to probe the possibility of the latter scenario as part of any investigation into a large organization that runs many programs.
We’ve spent a significant amount of time researching malnutrition treatment programs in the last few years, and made multiple grants, including to the large charity International Rescue Committee (IRC) and the smaller Alliance for International Medical Action (ALIMA). In late 2021, we published a blog post about why malnutrition treatment programs seemed extremely promising. But, although we did recommend grants for these programs, we have found it challenging to model their cost-effectiveness. In particular, we don’t have a clear sense from studies of how many deaths they prevent, due to ethical considerations limiting the research that can be done—it’s (justifiably) unethical to withhold malnutrition treatment, so it’s not possible to conduct a true randomized controlled trial of treatment vs. no treatment.
After conducting extensive internal research, plus hiring a couple of external experts to do their own analysis, we believe some malnutrition treatment programs are in the range of cost-effectiveness of programs we would consider directing funding to—i.e., similar to that of our top charities, which we estimate can save a life for roughly $3,500-$5,500. We still have major uncertainties about parts of our cost-effectiveness analyses, which we’re unlikely to resolve. But we think we may be able to reduce our uncertainty in other areas, and we’re moving forward with work on those aspects of our model. Simultaneously, we’re still investigating specific charities’ programs (in specific locations) as potential giving opportunities.
All that said, like you, we would be very surprised if the true cost to save a life (for any program, not just malnutrition treatment) were on the order of $210. Our cost per life saved estimates include all costs of running the program, including non-philanthropic costs (such as those covered by the government), and attempt to account for the other factors you mention, such as the fact that not all treated children would otherwise die from malnutrition and the likelihood that another funder would support this program if we didn’t.
If you’re curious to learn more, you can read a page about one of the grants we made to ALIMA here, and our most recent malnutrition treatment intervention report here.
I hope that’s helpful!
Best,
Miranda Kaplan
GiveWell Communications Associate
Hi, Nick,
Thanks for your comment! Apologies that it took a while to respond to this.
Re: how much funding is needed to successfully roll out the vaccine, we’ve provided a budget breakdown on the grant page. The majority of this funding is going toward training and other activities needed to distribute the vaccine, vaccine-related supplies, and shipping and handling for the doses donated by GSK. Only about $1.8 million of the total, or less than half, is going toward the costs of having PATH and WHO provide technical support for this project.
For every grant opportunity we evaluate, we do consider the likelihood that another funder will step in to cover the costs absent our support. In a conversation with PATH and WHO, we learned that there were no other suitable candidates for funding this rollout of RTS,S to comparator areas, though we didn’t independently verify this.
As for whether the governments of Kenya, Ghana, and Malawi could successfully speed up the implementation of RTS,S without NGO/WHO technical support, this is a subjective assessment. We frequently hear from NGOs that the governments where programs we fund operate tend to have many competing priorities, so progress on projects like this can be slow. The theory is that providing dedicated funding (and with it, human capacity) for a single project can accelerate the timeline of results. We try to confirm whether this is right by talking to other relevant actors, including government officials themselves.
It would be interesting to try out what you suggest—giving the funding directly to a country government to see if they could achieve the same results without technical assistance—but because there are so many country-specific factors that inform the success of an intervention, we think it’d be hard to tell if a slower vaccine rollout in a given country was due to lack of technical assistance or some other factor.
I hope that’s helpful!
Best,
Miranda Kaplan
GiveWell Communications Associate