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Coralie Oddy

Action on the refugee crisis and action on global poverty: thoughts, facts and ways to do good better. 

The Syrian refugee crisis has recently dominated news and social media. Away from the horror and devastation (not to mention the shocking apathy from some parties), 

I have been deeply struck by the compassion and support from ordinary people.

I know somebody who organised a donation drop for clothes and essential items for refugees in Calais that was inundated with contributions. My newsfeed keeps me constantly updated on news items about the refugee situation, shared and shared again with overwhelmingly sympathetic commentary and multiple calls for action. I’ve been asked to 

 by people I’ve never considered remotely political, and tens of thousands of people 

 to show their solidarity with refugees, giving up their time for an act of anonymous compassion.

My first thought on this is that I am tremendously proud, and somewhat awed, at our capacity for empathy.

 We are moved so deeply by the human desire to reduce suffering that we campaign tirelessly on issues that do not impact our own lives, and give generously to those we have never met and are never likely to meet. 

Our willingness to help others who are suffering acts as the measure of our humanity. We must keep up our efforts.

This chain of events has also led me to consider how we respond to the suffering of others in different contexts. As an effective altruist, I am concerned with how we can alleviate the most suffering, for the most people, in the best ways. While doubtless a humanitarian catastrophe we should all concern ourselves with, the current refugee crisis is an extremely complex problem to solve on both logistical and political levels. In contrast, we have a 

 that gives us comparatively straightforward guidance on what we can do to ease suffering and prevent deaths in the developing world.

 protects children from diseases that cause malnutrition, stunted growth, cognitive defects and increased risk of infection from HIV/AIDS. The immediate reduction in human suffering is immense, and long term these benefits to health support people to build better lives for themselves. The cost? Around 81p per treatment. It is with good reason that SCI is considered one of the 

But if that is the case, why has almost nobody heard of SCI? 

Given that the problem is so much easier to solve, and the level of human suffering broadly comparable

 (bereavement, poverty, physical pain and lack of opportunity are arguably just as bad whether caused by war or disease), 

why do we not see the same level of engagement the refugee crisis has sparked?

The refugee crisis is all over our media.

 Obviously, people are engaged with the suffering caused by the refugee crisis because it is constantly in the news. Also, because the situation throws up controversial issues (relating to immigration, for example), more people are inclined to voice their opinion. People feel they must argue for compassion as not everyone shares their views. This leads to more general discussion, but also an ‘us and them’ mentality which prompts people to validate the beliefs of others who share the same views on the crisis as themselves, encouraging action to be taken. 

With issues like extreme poverty in the developing world, the take-home point is this: 

just because an issue isn’t in the news, it doesn’t mean it isn’t newsworthy.

 Compared to the relatively sudden Syrian crisis, extreme poverty is a constant, and therefore is rarely commented on in the news. Yet it is because poverty is a constant fact of life for millions of people that we should be acting.

We know from the success of highly publicised events like Children in Need and Comic Relief that media coverage of extreme poverty creates empathy and a surge of generosity from the general public. We need to keep talking about poverty and how best to alleviate it by using relatable, human stories to promote effective charities as much as possible.

As with the refugee crisis, sparking a debate could increase engagement. 

 are a brilliant way to get people thinking about which charities alleviate suffering most effectively, and how and where we should be donating to make the biggest impact.

This refugee crisis is a relatively recent turn of events.

 In contrast, because of the notion that poverty is a ‘constant’, we think of it as being somehow ‘without end’; something which has always been present and always will be. Clearly, this is untrue: between 1981 and 2013, the number of people in the developing world living in extreme poverty has 

 from 50% to 21%, despite a 59% increase in population size.

To incentivise people to take action on extreme poverty, we need them to know what has been achieved as well as what still needs to be done. We should be promoting success stories and celebrating achievement, constantly working to discredit the idea that extreme poverty is a problem which can never be eliminated.

Public interest in the refugee crisis will fall and face the same difficulties - like apathy and lack of publicity - that reduce action on extreme poverty.

 Actions will lag long before they cease to be needed. Continuing to talk about issues, changes and, importantly, successes in the struggle is key to keeping up engagement with the refugee crisis and reducing the apathy that comes when a problem cannot be solved simply. I personally will continue to take action on the current crisis, and on global poverty as a whole. Which brings me to....

Emergencies like the Syrian crisis and ongoing problems like global poverty MUST be acted on, but possibly in different ways.

 In terms of global poverty, we know that giving to effective charities (such as those 

) is one of the most effective ways to impact the problem, but the same can't be said for emergency relief. According to the 

, emergency aid is one of the worst uses of donations in terms of effectively eliminating suffering.

 while donations to support refugees are unsustainable, 

grassroots political campaigning and lobbying may be the most effective way for ordinary individuals to limit the suffering of refugees

. We need to consider each of the issues we care about rationally, examining the evidence for what the best thing is to do in each situation.

We should be acting on both emergency situations and the ongoing battle to end extreme poverty, but also recognising that these situations are different and require distinct tactics to affect the most good.

 While our heart should call us to action, our head should tell us what needs to be done. Let's work on emergencies and ongoing poverty using the best tools we can, for as long as it takes.

Max Dalton

Should we give to SCI or fund research into schistosomiasis?

This blog post summarises my research on the cost-effectiveness of medical research. The full report can be found 

. I’d greatly appreciate comments on the full report!

At the moment, one of Giving What We Can’s top recommended charities is the 

 which distributes treatments for neglected tropical diseases to endemic regions. This has been demonstrated to be a highly cost-effective intervention, with a seemingly huge impact on people’s lives. It is great to do something that seems so obviously good, and effective.

However, it may be that there are even cheaper, more effective interventions out there. Perhaps we can discover a vaccine for schistosomiasis, or some insecticide that can disrupt their life cycle once and for all. Such interventions could be cheaper, and more effective, than the existing drugs for schistosomiasis.

If so, it might be worth funding research in order to develop these interventions. This one-off cost would open up such great new funding opportunities that it could be even more efficient than giving to SCI, in the long-run. 

It might be worth spending money on research now, that would pay off by having an even bigger impact on people’s lives later on.

So to find out how to do the most good, we should consider this other option: 

When selecting a cause you want to find something which is a significant problem (important), which you can have a big impact upon (tractable), and which others have ignored (neglected). This helps to ensure that you have a big impact, and are not duplicating work done by others.

There is an incredible amount of money spent on medical research - billions of dollars per year.[1] So how could medical research be neglected?

Well, when we look at the breakdown of that spending, we find that it is incredibly uneven. Diseases that cause 90% of the disease burden receive less than 10% of the medical research funding, an absurdly low figure.[2] And of 1393 drugs developed between 1975 and 1999 only 16 - just over 1% - were targeted at tropical diseases or tuberculosis, despite their significant disease burden. 

The tropical diseases that affect the poorest people in the world receive little funding.

Why? Most of the funding for medical research comes from governments in high-income countries, or from pharmaceutical countries focused on lucrative high-income markets. High-income countries have the money to spend on research, and they spend it on their own problems, whilst low-income countries can’t afford research, despite the massive impact it could have.[3] This is just what we see in health more generally: much more is spent per capita in higher-income countries, although a great amount of the disease burden is in lower-income countries.[4]

It therefore seems that tropical diseases are relatively neglected, and for the rest of this post I will focus on these diseases.

At first pass, it seems clear that this health research could be very important. It could find vaccines, drugs, diagnostics, and vector controls that could help to bring about the (near-) eradication of diseases that adversely affect millions of lives. But things aren’t quite so simple.

It may be that, for some diseases, no more health research is needed. For instance, it may be that, since the interventions against schistosomiasis are so cost-effective, there is no need for a vaccine, and if this is the case, schistosomiasis research is less useful.[5] We need to 

. It requires specific scientific knowledge to ascertain which diseases are most promising in this respect (something I discuss later).

One example of a disease for which a vaccine is needed is HIV. HIV not only has a massive disease burden, but is also a relatively expensive disease to treat, sucking up healthcare funding. Whilst there are some current control methods, like male circumcision and condom use, they are difficult to popularise. Having another tool to block transmission could greatly reduce the disease burden, and save healthcare spending that could be used on other diseases.[6]

Having established that some tropical diseases appear to be both neglected and important, we turn now to find out how tractable research is.

How much will it cost to produce a new drug or vaccine for this disease?

 This is a difficult question to answer. By its nature, research is the exploration of the unknown, and so we don’t know very much about the new drug or vaccine that will come out at the end of it (if we did, we wouldn’t have to do the research!). This means that we don’t know very much about the type and amount of research needed to get us to that finished product.

Nevertheless, we can get a reasonable idea by examining past drugs, and seeing how much it cost to develop them. One highly cited study finds that the average cost of developing a new drug is $800m.[7] There are some reasons to think that this might underestimate current costs somewhat: for instance, the figure is over 10 years old, and drug development costs appear to rise above inflation.[8] The true figure is therefore probably a little higher than this.

But it isn’t the average figure we interested in. We know that some diseases are likely to be much more simple than others. 

What is the development cost likely to be for the types of tropical disease that we are interested in?

Tropical disease research tends to be carried out by public-private partnerships, rather than by the private sector alone. It appears that these partnerships face lower costs, since their charitable purpose allows them to gain donations of equipment, or discounted prices, reducing their costs. Moreover, tropical disease research is often carried out in low-income countries, where trials are less expensive. Finally, fewer clinical trials are needed for the development of some of these drugs.

It therefore seems that the out-of-pocket costs of this sort of development may be less than half of the cost of private development, or less than a quarter if you account for the cost of capital, 

perhaps in the region of $150m-$178m.[9] So this sort of research could in general be significantly cheaper than most drug research could be.

However, it is important to note that this will vary by disease, and that some tropical diseases look particularly difficult to produce drugs for. For instance, HIV is a particularly complex disease, making vaccine development tricky.[10] This means that it is expected to cost much more to develop a vaccine for HIV - perhaps more like $15bn-$20bn than $800m.[11]

In order to truly assess the tractability of research into a specific disease, we need to investigate the particular scientific challenges relating to that disease. Though tropical diseases may be cheap to develop drugs for on average, 

we need to know the scientific challenges that a particular disease poses in order to fully assess tractability.

Estimating the cost-effectiveness of medical research

In the last section, we saw how much variation there was in neglectedness, importance, and tractability between diseases. We narrowed our focus onto a particularly promising set of diseases: tropical diseases (which are neglected relative to other diseases), that need a new type of treatment (and so are important), and that don’t seem to present particular scientific challenges (so are tractable). Homing in on the right disease is really important.

But it is also useful to come up with a rough analysis of the cost-effectiveness of interventions, to see if it is plausible that research into any of these diseases could be better than Giving What We Can’s current top recommended charities.

Giving What We Can’s top charities tend to be able to avert a DALY (a disability-adjusted life-year, which is a measure of health) for around $50. When I searched for estimates of the cost-effectiveness of research into tropical diseases, I found estimates ranging from $8-$235/DALY, with most estimates grouped around $10-$100/DALY. Inspecting the biases of these papers, it seems that these papers somewhat overestimate the effectiveness of research. 

The true figure for tropical diseases as a whole could be more like $50-$300/DALY.

there is likely to be a great variation in effectiveness between diseases, so these estimates indicate that the very best research could well do better than $50/DALY.

 The right type of research could be the most effective intervention we’ve yet found.

Unfortunately, we can’t yet be sure what these best opportunities are. But it is worth doing more research to find out what the best interventions are. We need to answer three questions.

First, we need to look at the current treatments available for tropical diseases, and the scientific challenges to creating new treatments. This will allow us to 

identify for which diseases research is both important and tractable

. Detailed scientific knowledge will be needed to answer this question.

gain a deeper understanding of the current funding situation, and which types of funding are most promising

. There are different ways to fund disease research: we can pay people to conduct studies (‘push funding’) or offer them prizes when they discover new treatments (‘pull funding’). Each of these types of funding has advantages, but each is likely to be especially suited to particular situations. A detailed analysis of how to use these funding mechanisms could help us to maximise impact.

develop better models for cost-effectiveness

. Many of the cost-effectiveness studies cited above failed to account for certain epidemiological considerations, or considered the average rather than the marginal impact of donations. Fixing these problems would allow us to build more reliable models of cost-effectiveness, which would help us to compare research to other types of intervention.

That is a research agenda. But we still need to ask: 

should we fund research into schistosomiasis, rather than give to SCI?

 We shouldn’t fund research just yet. While it seems likely that research overall is relatively effective, and that some research can be more effective than the current top recommended charities, we just can’t be certain enough about how effective it is, or which diseases need research the most. I expect that giving to tropical disease research will have a lower impact than giving to SCI.

in a few years, as we understand research better, I expect that to change.

In the meantime, it may be a good idea to put more time and money into answering the three questions I set out above.

Applied Clinical Trials Online: Sizing Clinical Research Market

COHRED: Assessing the Efficacy of Health Research as aDevelopment Strategy in Poverty Reduction - Strategy Papers, p. 6

 notes a strong correlation between Norwegian research spending and Norwegian disease burden, but a much weaker correlation with the global disease burden. It appears that Norway focuses on Norway’s problems.

The picture actually seems to be more nuanced than this: see Appendix 1 of my full report.

However, there are also concerns that an HIV vaccine would have low take-up due to social stigma, or that a vaccine might increase risky behaviour. ART (a drug that slow HIV/AIDS development) costs $500/year per patient. See 

Copenhagen Consensus: Vaccine Research and Development

for further discussion of these issues, and a cost-benefit analysis of further research.

The price of innovation: new estimatesof drug development costs

Disease Control Priorities in Developing Countries. 2nd edition., Ch. 6

. Note that a HIV vaccine seems highly important but relatively intractable. How cost-effective research is will depend on the tradeoff between those two factors.

Michelle Hutchinson

Giving What We Can is Hiring! Director of Growth.

In just five years, Giving What We Can has grown to over 1150 members in 30 countries worldwide. The community has pledged over $450m towards ending poverty. We are looking for additional hires to build on this success.

As Director of Growth you will be ensuring that interest in effective giving actually translates to more donations to effective charities, and thereby more people helped. You would be reporting to the Executive Director, Michelle Hutchinson.

Specifically, you would be responsible for:

Reaching out to people interested in donating effectively to offer answers to questions and other assistance

Chatting to people one on one about questions and concerns they might have about joining Giving What We Can, doing Try Giving, or donating to top charities.

Following up with people who requested more information or planned to get more involved later on, and ensuring that we have a reliable system for keeping track of them.

We’re a small team, so you’ll also have the opportunity to be involved in recruitment, fundraising, publishing our findings in the media and whatever else most interests you.

Be at the heart of an inspiring community of people who care about others and really put their passion into practice

: We have members all around the world, all of whom are dedicating a large part of their income to helping others as much as they can, and supporting each other in doing so. You would be getting to know these members, answering their questions, providing support to them and helping them to help others.

Work with friendly and intellectual staff

: You’d be working alongside a talented, interesting and highly motivated team.

: Giving What We Can shares an office with the rest of the Centre for Effective Altruism and with the Future of Humanity Institute, which is part of the University of Oxford. There are always fascinating people around, and we often hold joint seminars and training sessions, as well as many social events.

Be part of a fast-growing organisation and social movement

: It’s a hugely exciting place to be, and has opportunities for swiftly increasing responsibility

: Each new member of Giving What We Can saves around 10 lives, meaning that the right person in this job could help prevent over 100 unnecessary deaths each year!

This role has great potential for impact: Over the past couple of years, Giving What We Can has reached millions of people with its message of committing to donate the most effective charities. It’s crucial to ensure that people have all the information they need to act on that message. By leading our individual outreach, you can help move thousands of pounds to charity. In so doing, you would be interacting on a daily basis with large numbers of people who are passionate about helping others. As one of the key team members of a rapidly growing small organisation, you’ll have great responsibility, autonomy and room to grow.

If you work for Giving What We Can, you’ll be part of a focused team of intelligent, caring, enthusiastic colleagues who want to change the world, located in beautiful Oxford.

We’re looking for someone who cares deeply about alleviating extreme poverty as effectively as possible and is excited to get others on board with that aim.

You’ll need excellent written and spoken communications skills, to enjoy interacting with large numbers of people, be very conscientious and thrive as part of a team.

Some examples of experience that would be especially useful include journalism and sales – though we’re interested in anyone who can demonstrate the skills. Also helpful would be experience with customer relationship management systems such as CiviCRM or Salesforce.

Blog

Action on the refugee crisis and action on global poverty: thoughts, facts and ways to do good better.

Should we give to SCI or fund research into schistosomiasis?

Giving What We Can is Hiring! Director of Growth.

Giving What We Can is Hiring! Research Analyst.

Development, Population Growth and the Mortality-Fertility Link

Smart Legacy Giving

EA Global Oxford: Figure out the most good you can do and then do it

Is tobacco control a "best-buy" for the developing world?

An Update on Project Healthy Children

An Update on Project Healthy Children — Part II