GiveWell does not recommend any charities focused on vaccine funding and distribution. But we remain excited about vaccinations as a health intervention. The vaccination programs we’ve researched have been backed by strong, independent evidence of effectiveness and appear likely to be competitive with our top charities in their cost-effectiveness. We’d be excited to support a charity to implement these programs. This post will describe why we don’t right now.
In brief, we’ve been looking for vaccination giving opportunities over the last few years, but have continued to fail to find them. This is due to (a) lack of room for more funding and (b) UNICEF’s decision not to participate in our review process.
In particular, over the past 1-2 years, we’ve been looking for funding opportunities for measles, meningitis A, and maternal and neonatal tetanus vaccination. Each of these is discussed in greater detail below.
Measles and Rubella Initiative
We have nearly completed an assessment of the evidence and cost-effectiveness for supplementary measles and rubella campaigns. (We’ve summarized our current take below; more detail will be available in our full intervention report, which we hope to publish on our website this year.) These campaigns supplement routine, childhood immunization and aim to vaccinate all children against measles and rubella. In particular, children between the ages of 9 months to 14 or 15 years are targeted. The evidence that such campaigns — when targeting children under age 5, for whom the disease is most likely to be fatal — are effective appears to be strong and the cost-effectiveness (per measles death averted) is competitive with that of our top charities.
However, we don’t believe that the Measles and Rubella Initiative (the primary entity that supports these campaigns) has room for more funding to vaccinate children under age 5. We spoke with M&RI in January 2016 and representatives there told us (p. 4 at that link) that M&RI has a funding gap of approximately $36 million in 2016. Of the $36 million, $31 million would fund a campaign targeting 5-14 year olds in Ethiopia. Vaccinating children age 5-14 would, by reducing the number of people who could contract and transmit the disease, reduce infections in children under 5 and could potentially save lives. We have not pursued this opportunity because our guess is that this will be less cost-effective than our top charities. Gavi, a large alliance which funds vaccinations, has fully funded M&RI’s gap for vaccinations of <5-year-olds in Ethiopia but has not fully filled its 5-14 year-old gap. Though we don’t have information about why Gavi made this funding decision, it is consistent with our impression that filling the 5-14 year-old gap may be less cost-effective than the <5-year-old gap.
We believe the remaining $5 million gap for 2016 is very small compared to the size of M&RI’s total budget. As of November 2015, M&RI estimated (p. 15 at that link) $662.6 million in resource requirements for 2016. Note that this does not include the large campaign in Ethiopia, which has been carried over from 2015 to 2016. (Details here (p. 35-36) and here (p. 3).)
Thus, our impression is that the $5 million funding gap beyond the Ethiopia campaign represents an extremely small fraction of the total M&RI budget for 2016. The $5 million gap is so small relative to the total that we would guess that M&RI would be able to raise funding for it if it represented a pressing need, either from Gavi or another source. (We would guess that it doesn’t, since Gavi funds so much of M&RI’s work that it seems very unlikely that it would leave such a small gap.)
It also appears to us that there is no room for more funding in meningitis A vaccinations. We didn’t complete a full assessment of the evidence of effectiveness and cost-effectiveness for meningitis A vaccines because we learned early on in our investigation that there was unlikely to be room for more funding. However, our guess is that this intervention would be competitive with our top charities’ cost-effectiveness. Our meningitis A write-up concludes:
…[I]t seems unlikely that there will be room for more funding to support additional mass campaigns (or related immunization activities) in the meningitis belt in the near future. Gavi, a large funding vehicle for vaccinations, appears to have enough funding to fulfill its commitment to support all such activities in all 26 countries in the meningitis belt.
We’re not aware of any organizations other than Gavi funding meningitis A vaccine programs.
Maternal and neonatal tetanus campaigns
Vaccination campaigns to prevent maternal and neonatal tetanus appear potentially as cost-effective as our top charities. (More details are in our full report on this intervention.)
We have been following UNICEF’s work in this area, the Maternal and Neonatal Tetanus Elimination Initiative, since 2012. UNICEF recently informed us that it was declining to participate in our review process. We plan to write more about our understanding of UNICEF’s decision in the future. Our impression is that UNICEF is the primary funding vehicle for maternal and neonatal tetanus campaigns.
This is another example where we tried but failed to find a way to fund vaccinations. We are not aware of organizations conducting similar work, but would be interested in considering a similar opportunity if we identified one.