# The GiveWell Blog

Our goal with hosting quarterly open threads 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 or to request a call with GiveWell staff if you have feedback or questions you’d prefer to discuss privately. We’ll try to respond promptly to questions or comments.

You can view previous open threads here.

• Martin Randall on March 10, 2022 at 6:35 pm said:

Any thoughts on Ukraine related giving opportunities?

• Miranda Kaplan on March 11, 2022 at 1:30 pm said:

Hi, Martin,

Thank you for raising this topic. The staff at GiveWell share many of our followers’ shock and sadness at the crisis unfolding in Ukraine, as well as the desire to help. GiveWell’s focus remains, as ever, on finding the most cost-effective ways to save and improve lives on a daily, ongoing, longer-term basis; we generally don’t investigate giving opportunities related to humanitarian crises, such as those caused by war and natural disasters, so we unfortunately don’t have specific recommendations for giving to help relief efforts in Ukraine.

That said, we have written about giving during a crisis in the past. That blog post isn’t strictly relevant to the situation in Ukraine, but you may find some of the content helpful as you vet options for support (or for further clarification of our views on giving to disaster relief in general).

• Mark Pearson on March 11, 2022 at 3:30 pm said:

About five years ago, one of your senior advisors did a deep dive into the research around deworming [1] [2] and concluded the main research study relied on made him lack confidence “in the generalizability of that finding [of long term effects] to other settings.” Per [3], GiveWell concluded there is “weaker evidence on the causal relationship between reducing worm loads and improved life outcomes”. Nevertheless, GiveWell funds these programs because it still thinks “the possibility that deworming children has a subtle, lasting impact on [children’s] development” [4]. GiveWell admits this is a distant possibility, as it discounts the estimated long-term effects by 87% due to concerns about generalizability [5].

This is a big lack of confidence.

– You’ve expanded (hired more analysts).
– You likely have five years of additional information since the last update, either through academic research or data collected by NGOs.

P.S. Even if you can’t get more confidence that a certain long-term effect is real versus not real, at least you could get a better estimate of the “replicability adjustment” factor. This 2019 doc provides some ideas and mentions “a deworming replicability adjustment in the range of 5-30% (i.e., 70-95% discount) seems appropriate. Where one falls in that range requires a number of judgment calls.” So even if you can’t use newer data/studies put a better estimate of effect size and replicability and thus not need a replicability adjustment, at least you can shrink the uncertainty around that adjustment. Per GiveWell’s work, the adjustment factor can easily be off by a factor of 2.5 (current 13% adjustment version reasonable range of 5%-30%). That obviously has a lot of impact on how cost effective deworming programs look.

• Miranda Kaplan on March 17, 2022 at 1:56 pm said:

Hi, Mark,

Thanks for your comment. First, I want to note that you submitted a similar comment on the December 2021 open thread post, which we didn’t approve until just a few days ago. That was an oversight on our part, and we’re sorry this response is coming belatedly!

We don’t believe that there is significant additional valuable information to be gained from continuing to explore the existing literature on the long-term impacts of deworming. However, we are interested in funding projects to collect new data that would allow us to refine both our estimate of the effect size from deworming treatment and our replicability adjustment. For example, though we haven’t yet published a page about this, we recently recommended additional funding to the University of Washington for the ongoing DeWorm3 research study. This funding will support the principal investigators of DeWorm3 to create a plan to track medium- and long-term impacts on the study participants.

Additionally, in 2020 we introduced a new model to improve the methodology with which we estimate worm burden (more here). This is an important input into our cost-effectiveness analysis, given that one of our key uncertainties about deworming is the greater infection intensity among study participants in Miguel and Kremer 2004 relative to communities likely to be treated in deworming campaigns today. This update resulted in substantial changes to our cost-effectiveness estimates for some, though not all, programs and locations.

We also hope to write more and more clearly about the decisions we made in creating our current CEAs for deworming programs. However, much of our focus these days is on finding new granting opportunities to keep pace with our funds raised (see this blog post for more), and given existing capacity specifically on the research team that makes decisions about our deworming CEAs, we’re unsure of when we’ll be able to get to this.

• Sheridan on March 21, 2022 at 1:37 am said:

Is GiveWell considering the use of smart contracts to enforce donation matching? Smart contracts are good at solving some thorny coordination and incentive problems.

For example, a donor who wishes to give to a non-recommended charity A could set up a contract where they will give $X to charity A, unless another donor commits to give$X to GiveWell, in which case the contract forces the first donor to give the $X to GiveWell as well. • Sam Dyson on March 23, 2022 at 4:05 am said: I think it’s great that we should focus on treating malaria as the cost per life saved is relatively low and it has such a high yearly death toll. I was wondering, however, if there are any charities that you would recommend who are working on ways to eradicate malaria long term. I’m relatively new to the idea of EA and was wondering what the thinking is on diverting funds towards preventative measures rather than treatment. Apologies if this has been covered already. • Miranda Kaplan on March 24, 2022 at 2:09 pm said: Hi, Sheridan, We haven’t considered this before; thanks for bringing it to our attention. Though the idea is interesting, enforcing matches between donors seems to fall outside of our remit. We see our responsibility to donors as primarily to provide information to help them direct their donations, and not to facilitate coordination among them. However, we support donors exploring ways to achieve their goals for supporting effective giving. • Miranda Kaplan on March 29, 2022 at 12:39 pm said: Hi, Sam, Thanks for your comment! No worries about the retreading of any old ground; we’re happy to make our views more legible to readers. To clarify, all the malaria-focused programs that we currently support work on malaria prevention rather than treatment. The Against Malaria Foundation distributes long-lasting insecticide-treated nets (LLINs) that protect against malaria-carrying mosquitoes, and Malaria Consortium protects children against malaria during the high season of transmission via its seasonal malaria chemoprevention (SMC) program. (Malaria Consortium operates other malaria programs besides SMC, and some of those do include treatment, but our recommendation is only for its SMC program. We’ve also directed funding to Malaria Consortium for LLIN distribution.) Other interventions we’ve investigated, like intermittent preventive treatment for malaria (IPTi) and the RTS,S malaria vaccine, are also preventive. We don’t have recommendations for programs specifically targeting malaria eradication over the longer term. In general, we see our strength in identifying opportunities to help people in low- and middle-income countries over a relatively short period of time, and there continue to be large unfilled funding gaps in shorter-term malaria prevention. However, we note that all of the malaria interventions named above can be part of a country’s long-term malaria eradication strategy. Additionally, Open Philanthropy, whose work includes identifying opportunities to explicitly help future generations, has made a couple of grants related to malaria eradication that you may be interested to read about, here and here. • Sam Dyson on April 3, 2022 at 7:51 am said: Fantastic, Thank you for getting back to me and for the links! Cheers Sam • I think a quick win for accessibility would be to change your all caps navigation bar and footer to sentence case. I struggled to correctly type my email address in the email subscription box because it appeared in (small) all caps. The same goes for other areas of the site – for example your “XYZ COMMENTED ON” lines in the comments sidebar. • Miranda Kaplan on April 11, 2022 at 8:34 am said: Hi, Al, Noted—thank you for the suggestion! I’ve passed it along to our web team. • Vasco on April 16, 2022 at 4:50 am said: Hi, Firstly, thanks for your work! Secondly, I would be interested to know whether GiveWell has conducted cost-effectiveness analyses of the current top charities which take into account the long-term effects of the interventions on economic prosperity, population size and politics. • Miranda Kaplan on April 20, 2022 at 1:04 pm said: Hi, Vasco, Thank you for following our work! The cost-effectiveness analyses for our top charities do not estimate effects on economic prosperity, population size, and political developments in settings where these programs operate. We haven’t done any empirical research on this, but we broadly believe that the improvements in health and increased consumption we attribute to our top-charity programs are likely to have positive effects on general economic development. This blog post on “flow-through effects” elaborates on our reasoning. We do not attempt to gauge life-saving interventions’ effects on population size, in part because we don’t believe that overpopulation and associated harm are a significant risk. More in this FAQ and in a longer blog post about a study we commissioned on this topic from David Roodman. • ANGELO TOMEDI on April 22, 2022 at 11:09 am said: A recent article in Lancet (Malaria in 2022: A Year of Opportunity, DOI:https://doi.org/10.1016/S0140-6736(22)00729-2) stated that malaria mortality and incidence rates have not changed appreciably since 2015, and in fact increased by 12% and 7%, respectively, compared with 2015. Does this mean that all of the efforts of by AMF and Malaria Consortium have not made even a perceptible dent in the incidence and mortality? Not that the efforts are not worthwhile, but that is very depressing. • Miranda Kaplan on April 29, 2022 at 12:59 pm said: Hi, Angelo, It’s true that the World Health Organization has reported increases in malaria cases and deaths in 2020 compared with 2019 (see the foreword and “This year’s report at a glance” sections of WHO’s 2021 World Malaria Report). We are also saddened by this loss of life, which continued to be concentrated in children under five. It’s not clear whether the 2020 increases are indicative of a larger trend. The WHO report attributes them largely to: – Disruptions in programs that work on preventing malaria due to COVID-19. According to the report, supply chain disruptions and the resulting higher costs of purchasing, shipping, and distributing the commodities that these programs rely on seem to have been especially problematic. These led to, e.g. delays in LLIN distribution campaigns that may have left some households inadequately protected against malaria (see figure 2.11 on page 14 of the malaria report). – A 2019 update in WHO’s calculation of the distribution of causes of death in children under five. According to the report, this meant that the estimated percentage of deaths attributable to malaria between 2000 and 2020 rose, but it doesn’t reflect a larger trend. We base our expectation of the impact of AMF and Malaria Consortium’s SMC program largely on past randomized controlled trials that demonstrated the effectiveness of these interventions at reducing malaria rates. We are also interested in supplementing this evidence by directly measuring the impact of the SMC and LLIN campaigns these organizations support. On a global scale, this impact is difficult to gauge: GiveWell directs a lot of funding to these programs, but that total is still a small fraction of global funding for malaria, and SMC and LLIN distribution are only two of several types of anti-malaria interventions. On a more local level, we have funded some research that we hope will help us accomplish this—for example, we recommended funding to Malaria Consortium for monitoring and evaluation of an LLIN distribution in Ondo state, Nigeria, and Malaria Consortium is using GiveWell-directed funding for research to measure the impact of SMC in Mozambique (more here). • Oscar on May 2, 2022 at 8:01 pm said: I can see the value in evaluating giving opportunities in terms of how good they are relative to direct cash transfers. But I’ve always wondered why GiveWell spends so much money on direct cash transfers when you expect there to be other giving opportunities that are, say, 8 times more effective. Thanks in advance! • Miranda Kaplan on May 4, 2022 at 1:23 pm said: Hi, Oscar, We think that GiveDirectly is an excellent charity, which is why it’s remained on our top charities list since 2012. We rate GiveDirectly highly on three of four of our traditional criteria—GiveDirectly is transparent with us, its program is backed by evidence, and it’s able to put large amounts of funding to use. But, according to our cost-effectiveness estimates (which are very important inputs into our funding decisions, though they’re not the only factor), it’s substantially less cost-effective than other programs we’ve funded recently. Because of that, we haven’t made or recommended grants for GiveDirectly, beyond the minimum incentive grant we’ve recommended to Open Philanthropy for each of the top charities on our list, since 2015. You can see a record of all our grants to GiveDirectly since 2014 on this page. (Note that the table on that page doesn’t include gifts made to GiveWell but restricted by donors to supporting GiveDirectly, or donations to GiveDirectly made directly by donors using our top charities list, but not on the basis of a specific recommendation from us.) We’ve continued to use GiveDirectly as a benchmark of comparison for other funding opportunities because it is among the best charities we’ve identified, and because it can use enough funding that we don’t expect to fund anything less cost-effective than GiveDirectly. But we realize that having it on our “recommended” list—which individual donors may use to guide their giving decisions—and not actually recommending funding for it is confusing. As grantmaking becomes a more significant part of GiveWell’s work, we plan to improve our communication around our recommendations to donors, and we’ll share further updates later this year. For more on this, you may want to read “Why aren’t you just directing the extra money to GiveDirectly?” and “Why is GiveDirectly still a Top Charity?” on this page. • Oscar on May 4, 2022 at 7:54 pm said: Wow, thanks for the detailed response Miranda! That makes a lot of sense • Treon verdery on May 22, 2022 at 3:35 am said: Your thoughtful analysis of vitamin A supplementation suggests that it can save a life for about$3000 of child doses. The vitamin A chemical is already very affordable, but chemically could become 100-1000 times more dose potent with adding a fluorine atom to it. This effect of halogenation on drug potency is well known to chemists. Perhaps there could be some advantage to a new cheaper vitamin A molecule. What do you think?

• Treon verdery on May 22, 2022 at 4:27 am said:

At first glance, there does not seem to be a way to give money directly to Helen Keller International’s VAS (Vitamin A Supplementation) program without the money being shared with two other HKI programs, changing the amount to save a life through HKI to some amount other than $3000. I’d like to donate a miniscule$300 during June to their VAS program alone. Do you know of a way to do that without costing them administration expenses?

• Miranda Kaplan on May 25, 2022 at 2:43 pm said:

Hi, Treon,

Thank you for the suggestion and for your support of our recommended programs!

Re: your first comment, according to our analysis, lowering the cost of the vitamin A capsules used for VAS would not change the program’s cost-effectiveness by much. As you allude to, the capsules are already very cheap ($0.06 each), and they represent a small proportion of program cost ($0.78-\$1.42 per child, per supplementation round, depending on location). We don’t know enough about the chemical process of halogenation to know whether it would confer other advantages beyond increasing potency, such as making the nutrient easier to absorb.

Re: your second comment, in the past, direct donors to Helen Keller have been able to restrict their online donations to VAS by writing “VAS” in the comments of the online form. It seems as though the form has changed and no longer includes a space for comment. We’re checking with Helen Keller to see whether they still offer the option to restrict, and will update here (and update this page on our site) when we have an answer.

In the meantime, as an alternative, you may donate to GiveWell in support of VAS using this page (by filling out the box labeled “Helen Keller International’s vitamin A supplementation program” under “Support GiveWell’s top charities”). We do not take any fees, donations through GiveWell are tax deductible in the United States and the Netherlands (to the extent permitted by law), and donating through GiveWell allows us to better track the impact of our program recommendations.