The GiveWell Blog

All GiveWell’s grantmaking Posts

Research Strategy: Vaccines

| by Natalie Crispin

GiveWell started supporting vaccines in 2015 and has made over $160 million in grants to date. With strong results from past work in this space, we’re now exploring how to reach more people with vaccines in low- and middle-income countries. This post discusses our current thinking on vaccines grantmaking and our key hypotheses about where to focus our efforts going forward.

Where are we now?

Before this year, our grants for vaccine programs focused on (a) increasing uptake of the vaccines given to children in the first two years of life, and (b) speeding up the rollout of malaria vaccines.

Relative to other global health approaches, vaccines garner a lot of attention. Governments in high-income countries contribute to Gavi, the Vaccine Alliance, which heavily subsidizes the purchasing of vaccines in the world’s poorest countries and provides cash assistance to help these countries deliver them. The Gates Foundation is also a major contributor to vaccine programs. These efforts have been fairly successful—in 2022, 81% of children in the 57 low-income countries supported by Gavi had received the DTP3 vaccine, which protects against diphtheria, tetanus, and pertussis. DTP3 coverage is often used as a benchmark for progress on vaccination.

This provides both a challenge and an opportunity for finding cost-effective giving opportunities. On the one hand, thankfully, the people who are easiest to reach with vaccines are already being reached, which means more expensive or innovative methods are needed to expand coverage. On the other hand, we can build on the extensive knowledge and infrastructure that already exists.

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What If We Have Extra?

| by Jeremy Rehwaldt

What do you do if you’re in the very fortunate position of having more money than you need to meet your own immediate needs? You might find new things to buy. You might stockpile it for a rainy day. You might donate it to cost-effective global health programs. Or you might do some combination of the three.

GiveWell thinks about that same question.

First, a bit of context: All donations made to GiveWell’s Top Charities Fund, All Grants Fund, and recommended organizations go to the programs we recommend. (We do not take a percentage of donations made to recommended organizations through GiveWell’s website, nor do we receive any fees from organizations for being featured on our site.)

Our own organizational needs are met by donors who choose to direct funding to GiveWell’s operations (by giving to our Unrestricted Fund). In other words, we are supported only by donors who explicitly choose to support GiveWell itself through unrestricted donations.

But what happens when we receive more unrestricted donations than we need? We could choose to spend the funds on something new for the organization. We could squirrel those funds away, building an endowment to cover future needs. Or, like you, we could donate to cost-effective global health programs.

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Research Strategy: Water

(updated on: ) | by Erin Crossett

Water is a relatively new area of grantmaking for GiveWell, but we’re excited about its potential. Two billion people around the world lack access to clean drinking water, and unclean water is a major cause of illness and death, primarily through waterborne diseases such as diarrhea and cholera.

Within the water portfolio, we think about which specific programs in which specific places are likely to address these health burdens most cost-effectively, and what additional evidence we need to gather in order to make that determination.

In this blog post, we detail our current approach to our water portfolio, explore the areas we’re excited to investigate next, and share the work we’re doing this year to deepen our understanding of the sector. Through this work, we aim to make more highly cost-effective grants that bring clean water to many more people around the world.

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Increasing impact by combining programs

(updated on: ) | by Jeremy Rehwaldt

The idea has obvious intuitive appeal: If you’re already sending community healthcare workers door-to-door in (say) remote parts of Sierra Leone to deliver routine childhood vaccines, why not have those healthcare workers deliver chlorine for disinfecting drinking water, or oral rehydration solution for treating dehydration from diarrhea?

After all, if you’re already spending money on the fixed costs of delivery, why not provide other programs at the same time? You’d be able to amortize the costs across multiple goods and offer additional benefits to the community. (If you’re getting groceries delivered, it’s more efficient to have one driver deliver your eggs and milk and vegetables all together than to have separate drivers going round delivering each one separately.)

GiveWell is very interested in these “layered interventions,” and we are excited to support them wherever they cross our cost-effectiveness threshold. But we’ve discovered it’s harder than you might think to find ways to combine programs effectively.

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A major initiative to scale up water chlorination in India

| by Isabel Arjmand

We recommended a $38.8 million grant to Evidence Action to support the Indian government in providing clean water by setting up in-line chlorination in two states, Andhra Pradesh and Madhya Pradesh.

This isn’t a grant designed to directly deliver a service or commodity; instead, Evidence Action will use the funding to work in close partnership with state and local governments, providing technical assistance to support the delivery of the program. Providing all rural households with access to clean, piped water is a major priority for the Indian government. In-line chlorination, which uses a device to automatically disinfect water by adding chlorine as the water passes through a pipe, is a way to make drinking water safe.

We believe this grant may not only increase access to chlorinated water in the states it directly supports, but also inspire other states to adopt similar practices. A core part of the program’s theory of change is that governments in locations outside the grant area may take up a program they might not otherwise adopt. This is the first very large grant we’ve made where that’s been an important consideration. We think the upside is unusually high—if successful, this grant could eventually lead to tens or even hundreds of millions of additional people receiving safe water—but it’s also riskier than most of our grants, as there are a number of ways the program could fail to have the desired impact. Our hope is that this grant will reduce mortality and improve health at a very large scale.

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Malengo: Supporting students to pursue education internationally

| by Isabel Arjmand

GiveWell recently recommended a grant of up to $750,000 to Malengo, an educational migration program. Malengo supports students from low-income countries in moving to high-income countries for university. The goal is to enable them to earn a higher income over time, benefiting both the students and their families.

This post shares why we think Malengo’s program could be cost-effective, how filling this specific funding gap might enable Malengo’s program to become more financially sustainable, and what we hope to learn next.

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