Blog post

Every. Last. Child.

3 min read
28 May 2013


Despite the exciting advances being made towards polio eradication, Callum Calvert argues that your donations could make a bigger difference elsewhere.

In general, disease eradication efforts seem like they could rank highly in cost-effectiveness. This is because eradication today will mean the large on-going expenditure of controlling the disease can be diverted to other programs tomorrow. Despite this, one eradication effort that Giving What We Can is unlikely to recommend donating to is the Global Polio Eradication Initiative. This time, however, it is good news! A global focus on polio, thanks in part to the Gates Foundation, has led to new funding from some of the world's largest donors. Thanks to this, the area is now well-funded, so the marginal impact of an individual donor's dollar is likely to be much lower than previously thought.

GWWC had previously estimated the cost-effectiveness of donating to GPEI by building on a model from Eradication versus control for poliomyelitis: an economic analysis (Thompson and Tebbens, 2007). This model assumes that there are two possible futures, with the likelihood of each depending on GPEI's level of funding. If the required level of funding is reached then eradication will be achieved soon (scenario 1). Alternatively, if the required level of funding is not reached then eradication will not be achieved, and instead cases will rise to 200,000 per year until 20 years from now when polio will finally be eradicated (scenario 2). The value of a donation is then calculated as the probability that the donation leads to funding being met multiplied by the difference in DALYs between the two scenarios.

This model produced an estimated cost-effectiveness of 0.15 DALYs per dollar. This number is very low - indeed it would beat our current recommended charities if it were to be taken seriously. However, there are a number of reasons to believe that this estimate is over-optimistic.

Most importantly, this assumed that our dollar was as useful in bringing about eradication as each previously pledged dollar. This assumption becomes less true as the total funding increases because the dollar we donate goes (or should go) to the least effective part of the eradication effort. New funding makes this part of the effort less effective. The news that philanthropists such as Carlos Slim and Michael Bloomberg are joining the long list of large donors backing this program makes it unlikely that this program will come close to GWWC's top recommendations.

This is great news! It is a strange quirk for donors looking for the most cost-effective intervention that an improvement in the state of funding for an area leads to disappointment that it won't be an opportunity to help more people than we could before. GPEI hopes that their $5.5 billion plan will eradicate polio by 2018. While $1.5 billion remains to be raised it is unlikely that any failure will be due to lack of funding, given that the world's richest philanthropists and governments have given their backing to the plan.

Bill Gates, whose foundation has donated $1.8 billion to the program, has said that, if achieved, successful polio eradication will be "one of the great moral and practical achievements of our age". While GWWC won't contribute to this particular triumph, it will be exciting to watch as polio finally joins smallpox as the second human disease to be eradicated.

Image credit: CC-BY RIBI Image Library