# December 2015 open thread

Following up on our open thread in September, we wanted to have another one.

Our goal is to give blog readers an opportunity to publicly raise comments or questions about GiveWell or related topics (in the comments section below). As always, you’re also welcome to email us at info@givewell.org if there’s feedback or questions you’d prefer to discuss privately. We’ll try to respond promptly to questions or comments.

• 27chaos on December 10, 2015 at 3:08 pm said:

I feel kind of silly commenting when I know so little about it, but I recently learned that India has a desperately bad water situation, due to pollution, high population, and similar things. Their water situation is projected to get much worse in the future due to global warming and continued development.

I am wondering whether there might be bad habits among Indian people that hurt their hygiene or the quality of their water, similar to some of the bad practices related to health in Africa. I know there have been efforts to educate people about basic health in Africa, which seem to be somewhat good cost-effectively, and I think there might be potential for similar efforts in India.

Again, I know almost nothing about any of this. Also, I do know that creating new charities is not your role. But, have you looked into India’s water situation at all, to see whether or not good charities exist related to it? With their high population density, it might be possible to see disproportionately high results from charity intervention.

Thanks!

• Ian Turner on December 12, 2015 at 12:12 pm said:

Can you comment on your latest thinking about giving to Givewell vs to top charities?

• Tom Davies on December 16, 2015 at 7:50 am said:

My employer gives each of us a few days leave a year to work for a charity. People work in soup kitchens, clear noxious weeds from public land, or build websites for charities, but in general this type of leave is underutilized. Can you think of any contribution skilled software developers could make to you or your top charities?

• Could you possibly talk it bit more about giving now vs giving later — particularly for younger givers planing on giving throughout their life-time, steady giving starting early vs larger giving once they are more financially established.

• Jamie Cassidy on December 16, 2015 at 4:21 pm said:

Has there been any further movement on making the Open Philanthropy Project a separate organization?
I would like to donate to support Givewell’s traditional work but am less keen the OPP. Not that I don’t support what the OPP is doing but I don’t have a great understanding of it and so it doesn’t seem as clear cut to me as a best of use of my donation.

What ever happened with the project to try to improve the standard and accessibility of academic research? I feel like this was a really interesting and worthwhile cause but I haven’t seen it mentioned for a while. Is it still something you guys are pursuing?

I would love to see more detail on the total impact of the top rated charities. I don’t want to get too deep in to metrics as I generally agree with their concerns of their limitations, but taking the case of AMF the only number I have to relate to donations is the Givewell best guess of $2838 / live saved. I feel I would benefit from having more indepth understanding of what is going on to achieve this. For example it could take the form;$2838 will allow the to distribute ~ 535 additional bednets, our best guess is that this will prevent y people from contracting malaria, therefore avoiding x severe cases which would have led to some form of permanent damage to health and 1 expected death.

• Isabel McCann on December 16, 2015 at 7:13 pm said:

Thank you for this thread!

There are few organisations in the world that I respect more than GiveWell. But I wonder about the decision of some of your staff to give to you in the light of the fact that your recommendations are so similar to those of last year. Are you capacity constrained, so that you need more money to find other great charities? Are have you essentially identified the best charities a while ago, in which case, why do you need the money?

• Would you estimate that AMF or GiveDirectly raises wealth more per dollar given (given AMF reduces expenses and frees up time that can be spent earning income from not having to deal with Malaria)?

• Hi Ian, re: giving to GiveWell vs. to top charities, we’re aiming to publish an update in the next week.

• Vipul Naik on December 18, 2015 at 1:18 am said:

Thank you. There were a few concerns I had, this seems a good place to share them.

(a) Top charity reviews: My primary concern here is that an evaluation methodology that made sense when the amounts of money moved to top charities was small has not been adequately adapted to the scale of money potentially being moved in 2015 and 2016. Or to be more precise, at least the public description of the reviews doesn’t seem to have adapted to the significant increases in potential money moved.

First, I’d like to see more information in the reviews of top charities about the size of the domains within which these operate, how large a fraction of that domain the charity is, and how the changed allocation will affect that domain. For instance, in the case of AMF, something like “AMF currently accounts for about 1% of global anti-malaria philanthropy (or 0.15 of global philanthropic health spending), and with the planned influx of funds it can get to somewhere like 2-5% of such philanthropy.” [Numbers are illustrative and not necessarily accurate].

Second, it would be useful to discuss the effects of spending on the charity on practices within the domain, for instance, how does what AMF does differ from what other anti-malaria orgs do, and how does raising the stature of AMF affect practice in the domain? How does it affect the balance between the use of bednets, antimalarial drugs, and vaccine development efforts?

Until this year, I didn’t consider these questions to be as pressing because the amounts being moved (and the room for more funding suggested) for the orgs was quite small. However, at current levels I believe these become fairly important questions. My rough threshold is that if under 5 million are being moved a year these questions are not critical to answer, but when the amount’s north of 20 million then these do become quite important questions. To take a somewhat inapt analogy with the for-profit sector, when we think of a startup doing a seed round, the focus is more on “is the idea sound?” or “can it make money?” or “does it make sense overall as a business?” But when you’re in Series A or B and raising tens of millions of dollars then clarity about the TAM, SAM, and SOM become more important. I think GiveWell’s annual money moved is now at the level where these questions start needing to be addressed more explicitly.

(b) GiveWell’s own organizational growth plans and projections: I’d like to see more explicit estimates from GiveWell about:

(i) the amount of money it expects to move this year to top charities (uncertainty bars can be pretty huge but at least I’d like to see estimates). GiveWell aims to estimate numbers that are comparably complex about other organizations (including the charities it recommends) so it would be interesting to also make predictions about itself for the near term.

Relatedly, I really appreciate the quarterly updates on money moved and web traffic. However, the fact that the Q3 data doesn’t appear till January is somewhat unfortunate. Presumably in past years the significant staff shortage was a problem, but I think that with a combined staff of 30+ people and a GiveWell-dedicated effective staff of 12, publishing the money moved and web traffic number in December is both possible and (to me) desirable.

Having a good idea of how much money will be moved in expectation helps understand more clearly the impact of a marginal donation.

(ii) the way GiveWell expects its employee headcount, money moved, and list of recommended charities to evolve in the coming years (say over a five-year timeframe).

For instance, what’s the expected time for a new organization to actually make it to the top charities list? The top charities list hasn’t had any new additions since DtWI made it in 2013 (AMF was already around from before). This stability probably reflects the huge amounts of time and resources that need to go into evaluating a charity. What does this mean for the future?

With regards to the employee headcount, 2015 was identified as a year of hiring and training new employees, so that short-run output wouldn’t increase as much as we would expect from the employee headcount increase. I’d like more clarity on whether this rapid growth phase has now ended, and whether we can now expect to see improvements in overall output commensurate with the increased staff sizes. I’d also like the justification for continuing or not continuing rapid employee growth into 2016.

Also, the timeline for full separation of GiveWell and the Open Philanthropy Project would be valuable to have.

• Alexander on December 18, 2015 at 2:05 am said:

Thanks for the questions and comments!

27chaos: We haven’t looked at water or sanitation in India specifically, though we have reviewed the evidence for some water quality interventions. I have seen some evidence that poor sanitation may contribute to stunted growth in India specifically, but I haven’t investigated the question in any depth.

Tom: Thanks for the offer! While some of our top charities certainly rely on skilled software engineers (e.g. GiveDirectly and Segoviaa), we don’t generally have a great sense of how to use skilled volunteers successfully. (You’re welcome to reach out to the top charities directly with your question, of course.) For us, the management costs of working with volunteers have generally outstripped the benefits.

Chris: As you’ve probably seen, Holden laid out some of the relevant considerations on this issue back in 2011. For young donors just starting out, I’d personally recommend giving only a nominal (but personally meaningful) amount to inculcate the habit of giving prior to establishing a reasonable savings buffer, but I expect that some staff members would differ. My colleagues Milan, Helen, and Nicole all address their perspectives on this question to some extent in our recent staff giving post.

1. We’re still planning for Open Phil to become a separate organization, but we don’t have a major update on the timeline.
2. After conducting a medium-depth review, decided not to prioritize meta-research as a focus area for Open Phil, though we remain interested in science policy and infrastructure.
3. We don’t have good data on the x or y in your example. Our expectation is that AMF’s average cost per net delivered going forward will be $5.30, so you’re correct that we model a life saved for every 535 bednets distributed. The main benefits in our model–the only ones for the$2838/life save figue–are calculated from overall mortality figures (because that’s what the underlying RCTs measured) rather than malaria-specific mortality (which can be somewhat harder to measure). A quick proxy for seeing different staff members’ estimates of how much of the value of bednets come from source other than mortality prevention is comparing their cost-per equivalent life saved for bednets to the $2838 figure. The median staff estimate is that non-mortality benefits add about 50%. Sophia: We don’t really know the answer to this, but in our cost-effectiveness model we extrapolate the long-term income evidence for deworming to bednets and, after penalties for uncertainty, most staff members estimate that bednets do have a bigger net long term impact on income than cash transfers. We haven’t modeled a short term earnings boost. • Linch Zhang on December 18, 2015 at 7:56 pm said: I’m not affiliated with GiveWell, but here are my two cents: Tom: I think Alexander’s general intuitions apply to most other effective nonprofits as well. The employee organization at my company tried really hard to find modular opportunities to do effective volunteering, so we can donate our time as well as money. But it soon became apparent that for software people without a lot of spare time, the most effective ways of helping are typically simply giving money, and persuading other people to give money. That said, the EA (effective altruism) organization .impact does try to look for volunteer opportunities that are high-impact. Their projects are on hackpad( https://impact.hackpad.com/), and they typically meet over Google Hangouts to coordinate. Unfortunately it’s the holiday season and the next meeting isn’t until Feb 7th… Two projects you might be interested in: https://impact.hackpad.com/Good-Code-Projects-hZjP6bZsWm1 Good Code https://impact.hackpad.com/App-for-SCI-Health-Workers-kUGtJWRQohe App for SCI Health Workers (though this one might already be complete. You should check). Chris: The career advice site 80K Hours recently talked about a “personal runway” to maximize your long-term donations and altruistic contributions: https://80000hours.org/2015/11/why-everyone-even-our-readers-should-save-enough-to-live-for-6-24-months/ Personally, I think there is incredible urgency in giving now vs. giving later (because giving opportunities are drying up pretty quickly, and because giving now can help grow the nascent EA movement), but my views are definitely non-representative and most experts seem to disagree with me. Jamie: Regarding c, one thing you can do to get a handle on the uncertainties in GW’s estimations is to plug in your own best estimates (median, average, upper/lower bounds, etc) for various parameters into GiveWell’s spreadsheet for AMF: https://www.givewell.org/international/top-charities/AMF#footnote119_mrjqcqa Sophia: While there is a lot of uncertainty in those figures, I would recommend looking at GW’s other 2 charities: SCI or DWI, if you’re interested in long-term income/wealth increases. Most of the benefits from deworming comes from decreasing morbidity (that is, improving healthy functioning) rather than decreasing mortality (that is, preventing people from dying). Ex ante I would expect health increases to people already alive to have a much larger impact on wealth/income than saving lives would. Random plug: Ozy had a really cool post about why they give a significant percentage of their incometo really effective charities: https://thingofthings.wordpress.com/2015/12/16/we-can-be-heroes/ • A question I have is why local people don’t buy their own mosquito nets? It seems like they are inexpensive enough that most locals could afford them, and they should want to make the investment to save their children and themselves. It’s an even better deal since you avoid getting bit by mosquitos every night, so there is immediate benefit not just some potential future benefit. Deploying mosquito nets in your own house doesn’t require the whole community to work together, or a large outlay of personal or communal capital, or a lot of specialized expertise like a opening a new hospital, or expanding phone networks. Is it a lack of education about malaria and mosquitoes? That seems very unlikely. When you see your neighbors contracting malaria it is inevitable that everyone in the village will talk about it and get information about it. I have been to Africa several times myself, and know that the people there are smart and entrepreneurial and love their children, so I don’t see why they don’t solve this problem without outside help. Also, if you were to just give the locals a few dollars, would they use them to voluntarily buy mosquitos nets, or is there some other purpose that they would prefer to use the money for? What is that other purpose? Understanding their top priority is key to knowing why they don’t just buy mosquito nets themselves. I am suspicious of solutions that are delivered by outsiders that locals can easily implement themselves. • Alexander on December 20, 2015 at 12:27 am said: Juan – thanks for the question. We addressed some potential answers to this question back in 2012. I’d add that although I agree many people in malaria-prone regions are probably aware that malaria is a problem, that doesn’t necessarily mean that they recognize just how (cost-)effective bednets are at preventing child mortality, so I do see knowledge as potentially part of the problem. • Thanks for the link on reasons why giving out bednets is better than just giving cash. I have to say that I find some of the reasons stated in the linked blog pretty unconvincing: * Reason #1 – Positive externalities of bednets are not factored into individual purchase decisions. To believe this, you have to believe that local people think that the cost of bednets can’t be justified solely based on savings their children’s lives. To justify purchasing a bednet they have to also factor in the benefits to the community and these are too diffuse. Really? Spending a dollar to save their children’s lives is not a good enough return on their dollar investment? * Reason #2 – Bednets protect children rather than adults. The assumption here seems to be that the parents don’t care enough about their children to buy a low cost bednet, so outsiders need to do the job. Really? Why do the parents bother feeding the kids if they care so little for them? Also, even if you believe the argument that parents just don’t care about their children, malaria causes extreme sickness in adults. So adults should have direct selfish reasons to get bednets. * Reason #3 – Bednets are not available in the local market. This reason is VERY interesting. The question then becomes WHY are bednets not available? It must be that there is NO DEMAND. A few possibilities for this include: – There is a conspiracy to keep locals from getting bednets. Seems unlikely. – There is no market because locals don’t care about their children or their own health. These are the arguments in the blog that seem unlikely to me. – Locals don’t believe bednets work so they won’t pay for them. That is definitely possible. If bednets are promoted as a “cure” for malaria but there are anecdotes about people that use bednets but still get malaria, people could be convinced they don’t work. – Bednets are a big bother to use and care for. This could definitely contribute. – Using bednets requires a significant change to customs and habits and therefore a concerted “marketing” campaign is needed to get people to adopt them. This seems like the most likely cause to me. Inertia is a very powerful force in the world. If changing customs and habits is really the big problem, not the cost of bednets, then it is the “marketing” effort that accompanies the free bednets the really creates the benefits. It is the act of talking to the communities about the risks and benefits and following up with them to make sure they are using the bednets that causes the positive change. If you believe the above arguments, then a better solution might be to think of the malaria problem as a public perception and marketing problem rather than a lack of bednets problem. The free market doesn’t solve this because the financial gain in selling low cost bednets does not justify the large cost of changing consumer’s habits. Changing behavior through marketing is a well studied field. Perhaps we should look for ways to fund broad scale marketing efforts such as saturation advertisement on radio stations and billboards to create large scale demand for bednets rather than funding free bednets. The goal becomes how to change public perception and habits most cost effectively for the most people. One possibility is the way it is done today on a village by village basis, but that seems unlikely to be the most cost effective way to do it since the free market makes very little use of this method. • Dayton Thorpe on December 22, 2015 at 5:50 pm said: For several years, including this one, I’ve donated 10% of my income to GiveWell recommended charities. Last year I gave 10% of that to GiveWell. I am still happy with GiveWell’s research, but I will not be donating directly to GiveWell this year because I see significant mission creep. I see this in two ways: 1) I was disappointed that most of the new money GiveWell received seems to have gone into the OPP and not GiveWell’s previous research areas. I agree with your reasoning that new humanitarian interventions or new effective charities carrying out those interventions probably appear only rarely, but your update post acknowledges there were a number of charities you did not recommend simply because you didn’t allocate research resources to them. If you already have intimate familiarity with your top charities but still didn’t have the resources to research any new charities, I’m left suspecting that the resources you allocate to your traditional research areas have in fact decreased while your overall funding has increased. I hope the OPP gets split off as a separate entity soon so we can evaluate it on its own. Just like you, I’m skeptical of charities pursuing many programs at once that I can’t evaluate individually. I am interested in the OPP, but view it as significantly less effective than GiveWell’s top charities. 2) Your top charities have all grown quite a bit since you first recommended them. GiveDirectly in particular has thoroughly demonstrated the benefits of direct, unconditional cash transfers. It now seems more suitable for large donors pursuing low risk/low reward charities than for small donors who want to have an impact on small charities trying to prove their own effectiveness. It’s good to know where Good Ventures should send Dustin’s and Cari’s money, but where should I send mine? (This year, I’ll stick with AMF based on your recommendation.) • Alexander on December 22, 2015 at 8:10 pm said: Juan – I agree with some of these points, and I don’t think it’s unreasonable to prefer to give cash transfers rather than bednets on autonomy-respecting grounds. But I think the current empirical evidence suggests that giving away bednets leads to significantly greater takeup than other marketing efforts (one example). I also think it’s useful to think about giving out bednets as a form of marketing, perhaps the most cost-effective one available given how hard it might be to credibly convince people that bednets prevent (relatively rare) mortality. Dayton – thanks for the thoughts. We’ve definitely been spending more overall time on top charities research than in previous years, and I think it is somewhat reflected in improved quality in our reviews and cost-effectiveness analyses, but I agree that it hasn’t come through yet in additional new top charities. I don’t particularly agree with the characterization of GiveDirectly as “more suitable for large donors pursuing low risk/low reward charities.” If anything, we’d like to see GiveDirectly growing by doing more outreach to smaller retail donors, who we expect to have lower-effectiveness baseline giving and to provide a more sustainable long-run funding base. And I would say that our goal with the top charities has always been to provide fairly high-confidence, high reward opportunities (not “small charities trying to prove their own effectiveness”), and that the growth in AMF and GiveDirectly generally leads them to be better in that respect (though I agree that it does reduce some forms of non-linear upside a donor might expect). • Hi, I don’t donate specifically at Christmas, but prefer to direct a regular amount each month. I was wondering how you factor this into your room for more funding recommendations, specifically whether there can be an impact on charities from monthly funders switching charities at your recommendation. I ask this as before you have said that such donations are better because they allow charities to plan better for the future with known income. A concrete example: I was giving monthly to AMF until they ceased to be one of your top charities (in 2014 I think), I then switched my donation to SCI of the remaining options (partly due to considerations of the currency I could donate in). Should I now cancel a donation to a recommended charity in order to donate the same amount to a now more highly recommended option? If so, is this something that could impact the charity I cease to support? Is my monthly donation part of the charity’s assumed funding so that by ceasing to support it their room for more funding increases? My instincts suggest that monthly donations probably don’t make up the majority of funding and so perhaps the impact is low, but I wondered what you thought? Thanks, Tom G • Hi Vipul, thanks for the thoughtful comment. I’ve tried to respond to each of your items below. A) i) Re: the size of our top charities vs. the domain in which they currently work. We have been tracking the global net gap over the years, and our most recent analysis is here. In brief, Roll Back Malaria’s Harmonization Working Group estimates that there is a global need for approximately 180-280 million long-lasting insecticide-treated nets per year through 2020 with a gap for next year of approximately 40 million nets. Similar to your estimate here, very roughly speaking, AMF is aiming to fund 10-15 million nets over each of the next two years, so it accounts for approximately 6-7% (12.5/190m) of funding for LLINs globally. On deworming, we haven’t explicitly tracked the global gap in the same way, instead focusing on individual charities’ plans. We have limited information about the number of deworming treatments delivered globally, but the following provides some context. The WHO estimates that there is a global need for approximately 846 million treatments for soil-transmitted helminths (http://apps.who.int/neglected_diseases/ntddata/sth/sth.html, click “view country or regional data” in the lower left-hand corner for aggregate figures) and 259 million treatments for schistosomiasis (http://apps.who.int/neglected_diseases/ntddata/sch/sch.html, note that this includes adults). We estimate that SCI supported 25-30 million treatments in its latest fiscal year and that the Deworm the World Initiative supported approximately 41 million in 2015 (including both India and Kenya). (Unfortunately, it’s hard for me to track down a public source for this number. The vast majority of these treatments occurred in India: see footnote 41 here.) We don’t expect these figures to change dramatically in the coming years. ii) • AMF’s review doesn’t explicitly address the difference between its practices and other bednet distributors’, but this is something we’ve been tracking and writing about over the years. AMF stands out for conducting ongoing monitoring of its distributions and making this information publicly available. We have not found other organizations that consistently survey recipients of distributions and share that information with us, and our impression (see the previous link for some context) is that AMF stands out for its unusual commitment to data collection (not just sharing). AMF believes that its distributions will have higher coverage rates than standard distributions, though we have very limited evidence supporting this conclusion. (AMF made this case with respect to its follow up to a Global Fund-funded distribution in Malawi in 2013, some details here.) • We know less about this comparison with respect to deworming. • Deworm the World has shared a significant amount of high-quality monitoring information with us, and we have not seen this type of information from other organizations working oin deworming. • Our best guess is that funding SCI is equivalent to funding generic deworming programs and that its programs don’t differ meaningfully from other organizations’ programs. • GiveDirectly is the only organization we know of that is devoted to unconditional cash transfers. It is possible in all cases that these organizations will change the standard of practice in the domain. This strikes as more likely in the case of GiveDirectly than the others because this is one of its explicit priorities, but there is also some limited evidence that AMF has succeeded in convincing the government of Malawi to implement some of its data collection practices (more here). B) Re: our growth plans. I agree that we haven’t written as much about this as we could have and perhaps should have, and we’re planning more detail on where expanded staff time has gone in particular in the future. Some brief responses to your questions follow. i) We are still projecting$20-30 million total money moved from non-Good Ventures donors by January 31, 2016 (the end of our money moved year).

As of earlier this week (12/22), we had tracked $15.7m to top charities, and at that point in 2014, we had tracked$8.26m. We eventually tracked $13.00m, so we had received 64% of our total money moved as of 12/22/14. Direct extrapolation off of our current money moved implies that we will move a total of$24.7m this money-moved year. This estimate intuitively seems optimistic to me, but I haven’t done more work to arrive at a more accurate one. In past years this method of prediction has worked reasonably well.

We are hoping to publish a quarterly metrics post in the near future (ideally in the next week or so). Other giving-season related priorities have delayed it.

(ii)

With the caveat that I’m highly uncertain about this, my best guess is that GiveWell’s (entirely excluding the Open Philanthropy Project) headcount focused on research will stay relatively constant and perhaps grow slightly over the next few years. I do expect some growth in the number of staff devoted to (a) donation processing and (b) donor outreach.

Over the past couple of years, much of our capacity has shifted from GiveWell to Open Philanthropy (so staff growth has allowed us to maintain GiveWell while getting a new project off the ground) and staff we’ve trained have themselves focused on capacity building (recruiting, training and managing) new staff. It’s possible that some of this staff will be ready to produce more for GiveWell in 2016, but we’re still unsure about (a) whether or not they will be ready, (b) if they are, whether they will work on GiveWell or Open Phil, and (c) whether they will focus on output or capacity building.

We have little insight into our likely growth in money moved over the next few years. We are able to make reasonable estimates within a calendar year, but we don’t have much of a model for how year-on-year growth changes.
We’re hopeful that we will find new top charities but I would not be surprised if we don’t. We’ll be writing more about our plans for future research and hoping to get input and engagement from our audience in the next couple of months.

Our best guess is that GiveWell and Open Philanthropy will be separate organizations by the end of 2016, but the timeline is still highly uncertain.

• Jamie Cassidy on December 28, 2015 at 3:24 pm said:

Thanks Alexander. In general, while I’m a big believer in Givewell’s usual approach and value the hard facts, I am not opposed to an educated guess when necessary so I appreciate the additional colour.
I’ve done a little digging on the subject myself in the and going back to the paper Givewell uses for the child mortality reduction estimates (Lengeler 2004) they mention reduction overall disease occurance;
‘The effect of ITNs on uncomplicated clinical episodes of malaria is shown by large effect estimates in all trials. Overall, the reduction in clinical episodes was around 50% for all subgroups’
I’m not 100% certain I am interpreting this correctly, but it seems to suggest that malaria cases are halved by LLINs vs control groups. From the WHO website (which of the sources I looked for had the most conservative numbers) there will be approximately 190M cases of malaria in sub-Saharan Africa in 2015 out of a population of < 900M when South Africa is excluded (wow btw!). It's likely that the people AMF are targeting are much higher risk than average in this population, but keeping it conservative this would imply that the 535 bednets we discussed above would prevent 535*1.8*2.22*(190/900)= 451 cases.
I can't find any data on how many of these cases end up being severe enough to cause long term damage.
I find this extra information extremely important in my decision making process between GiveDirectly and AMF. It's conceivable to me, given child mortality rates in poor areas, that $2838 could end up saving a child's life, and so given the same ballpark of impact I would lean towards Givedirectly. But knowing that AMF with the same money would save an expected life and prevent so many occurrences of the disease makes it a much easier decision. I appreciate this is the conclusion GiveWell has recommended already but I feel a lot better about it having more clarity myself. Juan, I generally share the view that if the free-market isn't taking care of the problem we need to question why. Although I did find that reading Poor Economics gave me a better insight in to the problems with this rationality when dealing with the extremely poor, in particular their lack of access to reliable information. But more importantly I'd echo Alexander's point that when we have proof that a solution works we don't necessary have to have a philosophical reason as to why it should work to continue doing it. • Alexander on December 28, 2015 at 8:57 pm said: Thanks for the thoughts and questions! Tom: I agree that monthly donations aren’t a huge portion of the total, so I don’t think the stakes are super high, but in the case you describe I’d probably switch to AMF (assuming the currency issue isn’t a huge consideration). We always tell charities not to expect that their past GiveWell donations will recur, and in our room-for-more funding calculations we explicitly exclude past GiveWell-driven donations in projecting baseline revenue. In general, although I think monthly donations can be helpful in ensuring predictability for charities, I don’t think there’s a big gain for them from monthly rather than annual donations if you’re planning to reevaluate your giving annually. Jamie: Glad you found that helpful, and sorry to make you do it yourself! I’m not sure how helpful it is, but for what it’s worth my impression is that the average “uncomplicated clinical episode of malaria” looks a lot like the flu. • Jamie Cassidy on December 30, 2015 at 7:33 am said: Agreed re the flu comparison, definitely not as bad as I previously imagined. I spotted a flaw in my calculation of no. of cases prevented where I forgot to divide by 2, which would give 225 cases. That said I want to update the prevalence ratio, using the stat from the WHO that 40% of cases occur in Nigeria and DRC. This gives a ratio of cases per year to population of ~ 85.6/250 = .342 (fwiw I think this is still too conservative and a best guess would be .45). This gives a no. of cases avoided of 535*1.8*2.2*.5*.342 = 366 I also found a paper which shows that 5% of returning travellers with malaria have severe malaria (Genton 2001). It’s possible that this is an overestimate if the indigenous populations are genetically adapted to malaria, but there are other reasons why it might be an underestimate so I’m happy to go with it. This would equate to 366*.05 = 18.3 cases of severe malaria avoided for the$2838 donation.
Still can’t find anything on how many non-fatal cases cause long term damage.

• Philip on January 2, 2016 at 5:02 am said:

It looks like nobody really knows what proportion of malaria cases are “severe” but the educated rough guess in this WHO publication on severe malaria http://www.who.int/malaria/publications/atoz/who-severe-malaria-tmih-supplement-2014.pdf suggests 2 million global cases annually, so roughly 1% of all malaria cases.

It has been estimated that each year 135,000 African children under 5 become epileptic following cerebral malaria, compared with 305,000 African children under 5 who die from malaria. Epilepsy in a low-income African country is bad news, with facilities for diagnosis and treatment limited. It’s not clear what proportion recover and lead normal lives. Anecdotally, a child I knew of with malaria-induced epilepsy progressed from lying down helpless to being able to sit up and feed herself, after a couple of years of high-quality care.

AMF also says that every $1m spent on malaria prevention delivers$12m in economic benefits although they cite a Nature article by Jeffrey Sachs that doesn’t explicitly support that particular claim.

• Colin Rust on January 3, 2016 at 7:39 pm said:

Do you have a sense of how accessible GiveWell’s recommendations and analysis are in languages other than English? Or are there other orgs doing similar work published in other languages? For what it’s worth, doing some quick French language Google searches I don’t see much.

I wonder if it might be something to consider at this stage of GiveWell’s development. One approach would be to translate the key pages and host them on GiveWell’s website. A nice convention is to have a small clickable flag on a page to indicate that it is available in the corresponding language. Another kind of approach might be to try to encourage other websites to make use of GiveWell’s work (as e.g. Giving What You Can has in English), although it’s less clear what this would entail concretely for GiveWell.

• Colin Rust on January 3, 2016 at 7:55 pm said:

PS In French, I do see the site Altruisme Efficace has a list of organizations which includes GiveWell and GiveWell’s top charities (among others), basically clickable links and logos that lead to English-language sites. So that’s something. But for a French speaker who isn’t comfortable with English, it’s not great I think.

• Alexander on January 4, 2016 at 6:00 pm said:

Colin – thanks for the suggestion. We don’t have a great sense of how accessible our research is outside of English, though my guess would be “not very” – my impression is that our money moved comes from anglophone countries very disproportionately relative to their overall rates of international charitable giving. But we would currently guess that translating our research into other languages would be a pretty substantial undertaking for fairly modest gains in money moved (relative to the current availability of Google translate). We still haven’t ever produced a great set of “middle depth” content for people who want more than a paragraph but less than 10,000 words about our research, and I’d guess that that would take priority over translation into other languages, though I think the time when we get to that would be a good time to think a bit more about translation as well. I do agree that this could be a helpful role for some EA organizations in other countries to play, and I think we’ve seen that to some extent with organizations like this one in Switzerland.