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Michelle Hutchinson

Highlights from 2014 - 2015

At Giving What We Can, we're all about measuring impact. So, we regularly review our progress and activities. We're pretty proud of our last 12 month period — here are some of the highlights.

We want to make sure that we're keeping members, donors, and the general public in the loop with what we've been doing, and what we've got planned for the future. If you need more detail, you can also download:

Giving What We Can review Jul 2014 - Jun 2015

, more than doubling the number of members we had in June last year, which took us up to 1,118 members.

 through the Trust to highly effective charities, donated by around 

 started around the world, bringing the total to around 40

We had a large surge in membership in December and January — 223 people joined in those two months alone (for comparison, that is nearly double the number who joined during the whole of 2013). This seemed to be spurred largely by a pledging event held by students linked with the chapter in Cambridge, and perhaps also by a rise in charitable activity associated with the giving season.

Around this time we realised it would be more efficient to move away from organising outreach events ourselves, towards supporting 

 to run these around the world. Jon Courtney, previously Director of Community, switched to Director of Outreach to focus more of his attention of chapters in March.

As part of this new focus, in the first half of 2015 we supported the development of 15 new chapters, bring the total to around 40. We have also noted from Skype conversations with nearly 200 (15%) of our members that being able to connect with the community is important to many of us. Chapters therefore appear increasingly valuable not only as channels for reaching more people, but for supporting current members and sustaining the Giving What We Can community.

In November 2014 we changed the wording of our 

. Before this, the pledge specified that donations should be made to the most effective charities 

. We opened up the wording to make it more in line with the spirit which underlies Giving What We Can - that we should simply be helping others as much as we can. The change in wording allowed people who believe they can most effectively help others in ways other than fighting extreme poverty (or believe that that will be the case in future) to join.

We chose to do this after several months consulting members and individuals within the effective altruism community. The community feeling within Giving What We Can seems to be unchanged. The benefits of the change are somewhat difficult to gauge so far. They will likely depend on the extent to which the effective altruism movement takes off and whether those affiliated with it do in fact end up joining and donating 10% to the most effective charities.

; Alison Woodman joined as Director of Community and Hauke Hillebrandt became Director of Research in March. In April Sam Deere was appointed Director of Communications.

Alison’s role will allow us to learn more about our current membership and therefore support our community, as well as track the impact we are having. Hauke is helping to develop a long-term research strategy and has written in-depth reports on each of our currently recommended charities. Sam is has been represented us in media appearances, talks and news articles, whilst also working on creating a new version of 

The full potential of chapters, particularly when they work on something they are really excited about – we estimate that the Cambridge pledge event led to 83 new members.

In research, our comparative advantage continues to be identifying crucial considerations, particularly those emerging from the academic literature – such as the link between soil-transmitted helminth infections and malaria. Continuing to keep up with these kinds of developments will therefore be a significant focus for us.

The usefulness of automating processes such as bookkeeping and some parts of outreach, and therefore the importance of having someone on staff with significant tech skills.

We have continued to be very fortunate in the volunteers we attract, which has been useful for research and for blog writing – not just our own, but also now for the Huffington Post. That is likely in part because of our excellent blog manager and in part because of being based in Oxford. Given the value this has brought, we should continue to try to be appealing for volunteers to work with.

We fundraised for our 2015 budget over a 2 month period in April - May. That was the wrong time of year from a tax perspective, and the long time frame meant we were uncertain about our financial position for a long time. We will therefore be fundraising for our 2016 budget over the first two weeks of December 2015.

We recently released our 12 month plan for July 2015 to June 2016 which you can read in full 

. Here’s a short summary of our goals and plans. Our primary metric for impact is number of members. We aim to have 2000 members by the end of June 2016.

Over this year a large part of our focus is going to be on improving our understanding of the journeys people take towards becoming members, and how we can improve them. We have developed a Pathway Model which makes explicit our underlying assumptions about how people move from being unaware of Giving What We Can to taking the Giving What We Can pledge, and offers suggestions of factors that influence whether they will advance through any of the intermediate steps.

Below are the main steps we have mapped out which influence the paths people to go through on the way to becoming members:

A) Making people aware of Giving What We Can and effective giving

C) Inspiring people to want to get involved

D) Encouraging people to become a part of Giving What We Can

E) Supporting people to remain long-term active members

It is likely that it will be higher value to put in work at some points of the pathway than others. One reason for this is the relative crowdedness of the different parts.

At the moment we are not planning to spend as much time on increasing awareness abouteffective giving and Giving What We Can as we are on later parts of the pathway. There are currently a number of people focusing on media attention for effective altruism and the relevant organisations, through books, mass media and conferences.

Two of the biggest ways in which we think we can contribute here are encouraging in-person meet-up groups and supporting people at later stages of the pathway. Supporting people at later stages of involvement seems more likely to be our comparative advantage, as it often requires long-term follow-up and time-consuming outreach to individual people, which volunteers are less likely to be in a good position to do.

We are currently in the process of carrying out a recruitment round, looking for both a research analyst and at least one person in an outreach role. The number of applicants we take will likely depend both on the quality of applications we receive, and how our fundraising goes.

We will be opening another round of fundraising at the beginning of December in order to raise our budget for 2016. In the next month we will be updating our impact evaluation estimates with recently-gathered data about donations made during 2014.

As always we’d love for more people to get involved in whatever ways they can. Here are just a few ideas:

Join a local group, or get in touch with Jon (

) about setting one up if there isn’t one nearby

Write for our blog. We’re always looking for people who are enthusiastic about writing for our blog. Whether or not you have a clear idea of what you’d like to write about, get in touch with Carolina (

), our blog manager, if you’d be interested.

Give us feedback. If you have comments about our website, community support, research, local groups or any other aspect of our work, we’d always welcome them. You can send feedback to 

Jean Davis

Where should we donate to do the most good? - Essay Competition 3rd Prize

Cash Transfers: Helping Households Adapt to a Changing Climate

With 17 new Sustainable Development Goals (SDGs) recently announced, the United Nations member states will again put eradicating poverty, in all it’s dimensions, at the heart of the global agenda.This time the focus is on sustainability, with environmental degradation and a changing climate being recognised as two of the greatest threats to meeting UN aspirations.

This year, it is estimated that global temperatures are set to rise one degrees centigrade above pre-industrial averages for the first time, halfway towards the two degree boundary that was agreed by parties at the 2010 United Nations Framework Convention on Climate Change (UNFCCC). The next UNFCCC will occur in Paris in December this year and securing a high-ambition climate agreement will be key to achieving the SDGs and vice versa. Even with affirmative action the effect of a global climate deal won’t be truly felt until after 2030.[1]

Those whose livelihoods depend on the areas most vulnerable to climate change and with fewest resources will be disproportionately affected and less able to adapt to the effects. It is vital that governments put in place the social policies required in order to protect those most at risk. [1,2] The key to this is to connect the economic, social and environmental aspects of development absent in the Millennium Development Goals. The 2013 UN Report on the post-2015 development agenda states that ‘environment and development were never properly brought together. People were working hard – but often separately – on interlinked problems’.[1] Cash transfers are an effective, well-evidenced, scalable, cost-effective method to combine the above and help the most vulnerable households adapt to the effects of a changing climate before 2030.

This photograph was taken in 2012, when 13.3 million people in Kenya, Ethiopia, Djibouti and Somalia, once again faced loss and suffering due to a drought, the worst in 60 years, in the region.

Cash transfers are direct, regular and predictable non-contributory payments that raise and smooth incomes. The goal is to reduce income poverty and vulnerability.[3] They can either be unconditional, in that they do not require recipients to engage in any specific activity (for example, to visit primary health care facilities) or conditional. These programmes have already provided well-evidenced interventions in a number of middle income and some low-income countries for general indicators in health, education and poverty reduction.[4]

Many of these indicators help to meet the existing needs of the poor and therefore assist households to adapt to climate change as they help families to survive in times of crisis. This includes many responses to stress that weaken the long term ability of families to deal with future challenges and improve their livelihoods long-term, especially for those living in rural areas. This might include selling productive assets like farm equipment and fertilisers or taking on high interest debt.[4,5]

For example, Ethiopia’s Productive Safety Net System (PSNP) protects assets, such as food and livestock, from being sold to provide for immediate needs, and from the early harvesting of crops.[6] In many cases, families have even been able to invest in their long-term livelihoods further increasing their stability and adaptive capacity: after a cash transfer program in Zambia, Goat ownership by families in Zambia’s Komolo district went from 8.5% to 41.7%, the number of households investing in enterprise quadrupled and the average investment doubled after a cash transfer programme aimed at increasing entrepreneurship was introduced.[7]

Climate change interventions rely on complex models that are location specific and have high rates of uncertainty which makes them difficult to plan and scale.[4,11] Cash transfers do not require an understanding of these complexities, either by recipients or coordinating agencies, as the decision on spending lies at the household level.

The level of control given to households regarding their spending, sometimes with no conditions, raises concerns around an increase in the consumption of temptation good such as alcohol and cigarettes, however most evaluations have reported no significant increase in spending in these areas.[12] Social protection programmes are also often criticized for dissuading wage earning by working adults, however cash transfers are evidenced to lead to reduced child labor and at most modest disincentives to work in some cases.[12]

Some of the best examples of cash transfer programmes originate in Latin America and were designed with strong monitoring and evaluation structures in place, which has lead to robust learning and expansion4. For example, Mexico’s Oportunidades Conditional Cash Transfer Programme reduced the poverty of beneficiaries by 30% and that of the poorest of the poor by 45% (by some measures). This suggests that the most important reductions in poverty are taking place among the poorest households[8,9], which makes cash transfer an excellent candidate for targeting the poorest of the poor.

Cash transfer programmes can be easily adapted to meet local needs and capacities, or target specific indicators important to organizations and governments. [4] In addition, well-documented monitoring and evaluation data have lead to the building of excellent frameworks for implementation. Cash transfer has been shown to be no more expensive than other interventions with similar outcomes, though like-to-like comparison of cost-efficiency is exceptionally difficult to measure; however, generally cash transfers have lower administrative and overhead fees.[10]

The success of the SDGs is intertwined with the progression of climate change. We must think about the effect that climate change will have on the poorest and most vulnerable within society who are least able to adapt and help households adapt by 2030.Cash transfers are a no-regret social policy with a range of indirect outcomes, and few, if any negative consequences, that can be used to achieve this. As some of the most well evidenced, easy to adopt and scalable interventions cash transfer programmes have great potential. However they are no panacea, and require multi-level sustainable development of the economy, society and environment to be ultimately effective.

DAVIES, M., A. Barrientos, S. Devereux, S. Hickey, R. Sabates-Wheeler, B. Guenther, and I. Macauslan. UN, 2013:A New Global Partnership: Eradicate Poverty and Transform Economies Through Sustainable Development. The Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda. 2013

FIELD C.B., V.R. Barros, D.J. Dokken, K.J. Mach, M.D. Mastrandrea, T.E. Bilir, M. Chatterjee, K.L. Ebi, Y.O. Estrada, R.C. Genova, B. Girma, E.S. Kissel, A.N. Levy, S. MacCracken, P.R. Mastrandrea, and L.L. White (eds.). IPCC 2010:Climate Change: Impacts, Adaptation, and Vulnerability. Part A: Global and Sectoral Aspects. Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge University Press, Cambridge, United Kingdom and New York, NY, USA, 2010.

DAVIES.M. DFID Social Transfers Evaluation Summary Report. IDS Research Reports, 2009: 1–36. doi: 10.1111/j.2040-0217.2009.00060_2.x

WOOD. R. G. Is there a role for cash transfers in climate change adaptation? International Conference: “Social Protection for Social Justice”. Institute of Development studies, UK, 13-15 April 2011.

PARRY. M.L, O.F.Canziani, J.P. van der Linden and C.E. Hanson (eds). Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on climate Change, Cambridge University Press, Cambridge, UK and NYC, USA, 2007.

SLATER, R. S. Ashley, M. Tefera, M. Buta and D. Esubalew. Ethiopia Productive Safety Net Programme (PSNP): PSNP Policy, Programme and Institutional Linkages. London: Overseas Development Institute, 2006.

SCHURING. E.Social cash transfers in Zambia; A work in progress. [online] [Accessed 30/08/2015]Available from: 

http://www.academia.edu/3103799/Cashing_in_-_How_cash_transfers_shore_up_Zambian_households_affected_by_HIV

NIGENA. G and L.M. González-Robledo. Lessons Offered by Latin American Cash Transfer Programmes: Mexico’s Oportunidades and Nicaragua’s SPN. Implications for African countries. Centre for Social and Economic Analysis. Mexican Health Foundation. June 2005 (paper) DiFID Health Systems Resource Centre

SKOUFIAS E. and B. McClafferty. Is Progresa working? Summary of the Results of an evaluation by IFPRI. Food Consumption and Nutrition Division International Food Policy Research Institute No. 118 Washington, DC 2000.

GOVERNMENT AND SOCIAL DEVELOP MENT RESOURCE CENTRE Helpdesk Research Report; Financing and Cost-effectiveness of Cash Transfer Schemes. August 2010.

MORTON, J.F. The impact of climate change on smallholder and subsistence agriculture. Proceedings of the National Academy of Sciences in the United States of America, Vol. 104, No.50 (Dec.11, 2007) pp.19680-19685

GIVEWELL. Givedirectly Report. [online]. [Accessed 29/08/2015] Available from: 

http://www.givewell.org/international/top-charities/give-directly

Dan Frost

Where should we donate to do the most good? - Essay Competition Runner up

The question of where charitable funds should be directed is not a simple one.

The Global Fund to Fight AIDS, Tuberculosis and Malaria

 (The Global Fund or TGF, henceforth). This cause was selected because it is scalable. The organisation was chosen based on evidence of their past work, potential cost-effectiveness of additional funds and the capacity they have for added funds.

This framework for selection is valuable and the recommendations of this paper are solely based on this criteria. However, this does not account for a donor’s unique passion for a particular cause, which is undoubtedly important when making a donation. Nonetheless, the framework does allow for an impact-based conclusion and a recommendation for those who want to see the best value for their donation.

Preventing and curing AIDS, tuberculosis and malaria are certainly scalable interventions, due to the high burden of disease. Combined, they account for 8.61% of the global disability-adjusted life years (DALYs) (Murry et al., 2012), which measures the number of years of life lost due to ill-health, disability or early death. The three diseases combined account for 5 million deaths each year (Vitoria et al., 2009), and in low income countries they constitute 3 of the 5 infectious diseases that caused the most deaths each year (WHO, 2008). These statistics show that the problem is sizeable and unresolved.

The means for education, prevention and treatment of these diseases are available. Standard antiretroviral therapy (ARV) is a course of drugs used for treating HIV. Within 4 years of the drugs becoming available, death rates caused by AIDs related illnesses fell by 84% (Porter, 2003). The main instrument in the prevention of malaria is distribution of insecticide-treated nets, which halves the cases of malaria among children (The Global Fund, 2015). Tuberculosis is treated with short-course chemotherapy, which delivers an approximate success rate of 83% (Espinal et al., 2000). These interventions are clearly scalable and have great potential for impact.

The Global Fund is a financial organisation that provides funding primarily to governments of developing countries to allow them to enact the necessary measures to tackle the problems of HIV/AIDS, malaria or tuberculosis. Grants are applied for and then reviewed by the Global Fund’s Technical Review Panel. If granted funding, the project is required to have set targets that are overseen by Local Fund Agents. These are independent bodies that monitor the progress of grantees.

The Global Fund is responsible for a lot of the progress against these diseases so far. As of 2015 the Global Fund provided financing for 12.3 million cases of tuberculosis detection and treatment, 450 million insecticide-treated nets and 7.3 million people receiving ARV. It also provided approximately 20% of global funding for HIV/AIDs and 66% of funding for tuberculosis and malaria projects in 2005 (Schoken, 2005).

The large scale of the Global Fund inevitably raises questions of whether it still has the capacity for additional funds, or whether the marginal returns to these funds will have been diminished due to the size of the organisation. However, from 2013 to 2014 donor pledges fell by 32% (TGF Annual Report, 2014), likely due to weakened economic positions of donor governments, who are by far their largest donors. This reduction in pledges led to a reduction in grants by 21.7%.

Therefore, despite its size, The Global Fund still has capacity for added funding. It undoubtedly would have provided more grants were it not for the fall in pledges. Hence, the organisation is not at full funding capacity, due to the dramatic fall in donations in recent years.

The Global Fund would use additional funds in a way that is cost-effective. Firstly, the projects that it funds use proven, cost-effective methods. Tuberculosis treatment, for example, is estimated to be ‘among the most cost-effective of all interventions available’ (Chapter 2, Laxminarayan et al., 2006) in improving health in developing countries. HIV/AIDS treatment and prevention are generally estimated to be cost-effective. One example where it is very cost-effective is in the prevention of mother to child transmission, which can cost as little as $6 per DALY averted (Laxminarayan et al., 2006), while conventional ARV drugs therapy ranges from $13,000 to $23,000 per quality-adjusted year of life gained (Freedberg et al, 2001). Malaria prevention through distributing long-lasting insecticide-treated nets is also very effective: it is estimated to save one life per $3,300 spent (givewell.org, 2013).

Not only are available methods for the causes cost-effective, but The Global Fund is also a strong organisation for carrying out these interventions, due to the structure of its grant distribution. After a grant is awarded, ‘continued funding is dependent upon demonstration of proven results’ (pg. 7, TGF Annual Report, 2014). And this principle is enacted, with the least effective grants losing their funding if they do not meet targets. For example, in 2005 The Global Fund removed funding from Myanmar due to suspicions that their grants were not being used for their intended purposes (Parry, 2005). This process ensures that the areas where funds are not used effectively are avoided over time, so that only the cost-effective projects remain funded.

The Global Fund’s current financial status and cause selection make it an excellent charity to donate to. It makes effective projects possible through provision of funding, and offers excellent value per unit of donation.

Chow J., Laxminarayan R., and Shahid-Salles S. A., (2006). Disease Control Priorities in Developing Countries. 2nd edition. [online]. Available at: [

http://www.ncbi.nlm.nih.gov/books/NBK11784/

Espinal, M., Kim, S., Suarez, P., Kam, K., Khomenko, A., Migliori, G., Baéz, J., Kochi, A., Dye, C. and Raviglione, M. (2000). Standard Short-Course Chemotherapy for Drug-Resistant Tuberculosis. JAMA, 283(19), p.2537.

Freedberg, K., Losina, E., Weinstein, M., Paltiel, A., Cohen, C., Seage, G., Craven, D., Zhang, H., Kimmel, A. and Goldie, S. (2001). The Cost Effectiveness of Combination Antiretroviral Therapy for HIV Disease. New England Journal of Medicine, 344(11), pp.824-831.

GiveWell, (2013). Mass distribution of long-lasting insecticide-treated nets (LLINs) | GiveWell. [online] Available at: [

http://www.givewell.org/international/technical/programs/insecticide-treated-nets#HowcosteffectiveisLLINdistribution

Murray, C., et al. (2012). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859), pp.2197-2223.

Parry, J. (2015). WHO | Global Fund withdraws grants to Myanmar. [online] Who.int. Available at: 

http://www.who.int/bulletin/volumes/83/10/news11005/en/

Porter, K., (2003). Determinants of survival following HIV-1 seroconversion after the introduction of HAART. The Lancet, 362(9392), pp.1267-1274.Vitoria, M., Granich, R., Gilks, C., Gunneberg, C., Hosseini, M., Were, W., Raviglione, M. and De Cock, K. (2009). The Global Fight Against HIV/AIDS, Tuberculosis, and Malaria: Current Status and Future Perspectives. American Journal of Clinical Pathology, 131(6), pp.844-848.

Schocken, C., (2005). Overview of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Center for Global Development [online]. Available at: 

http://www.cgdev.org/page/overview-global-fund-fight-aids-tuberculosis-and-malaria

The Global Fund (2014), The Global Fund 2014 Annual Financial Report. [online] Available at: 

http://www.theglobalfund.org/en/publications/annualreports/

The Global Fund to fight AIDS, Tuberculosis and Malaria, (2015). Fighting AIDS, Tuberculosis and Malaria - The Global Fund to Fight AIDS, Tuberculosis and Malaria. [online] Available at: 

http://www.theglobalfund.org/en/about/diseases/

Vitoria, M., Granich, R., Gilks, C., Gunneberg, C., Hosseini, M., Were, W., Raviglione, M. and De Cock, K. (2009). The Global Fight Against HIV/AIDS, Tuberculosis, and Malaria: Current Status and Future Perspectives. American Journal of Clinical Pathology, 131(6), pp.844-848.

Who.int, (2015). WHO | The top 10 causes of death. [online] Available at: 

http://who.int/mediacentre/factsheets/fs310/en/index4.html

Alex Mann

Reach for systemic change

GiveWell moved $27.8 million to effective charities

. At the same time, the U.S. government spent over 

mass distribution of insecticide treated nets (LLINs)

. Clearly, the impact of increasing the portion of foreign aid allocated to effective programs focused on evidence-backed interventions could have an enormous impact. The only question is 

: is investing in influencing policy likely to yield results?

A shallow investigation of the impact of lobbying seems to indicate very high initial returns on investment. For example, certain groups have estimated the ROI (return on investment) of lobbying to 

Unlike with direct charity such as AMF, opportunities to influence policy come and go quickly. Issues that originally seemed intractable can 

. Some organizations are able to achieve such an impressive ROI because they have invested in infrastructure and network development. When opportunities arise, they can 

The Reach Act, which prioritizes proven, effective interventions, should be of particular interest to effective altruists. USAID estimates that passing it could save the lives of 

600,000 mothers and 15 million children between 2015 and 2020

While policy wonks such as Amanda Glassman and Lauren Post at the center for Global Development are enthusiastic about the bill, they note that to ensure it delivers real impact, targets need to be 

achievable, measurable, appropriate, and regularly tracked

 while new investments are also brought in. For more thorough analysis of the bill see posts by the Center for Global Development 

Even if USAID’s estimate is overly optimistic, the bill will likely have a very significant impact on global welfare if passed. Given that it will be directly affecting how billions of dollars are spent on high impact interventions, the difference between the best and worst case scenarios might be measured in millions of lives. Effective Altruists should take note.

Ray Kennedy

Where should we donate to do the most good? - Essay Competition Winner

Where should we donate to do the most good?' What is the most effective, scalable, evidence-based, but currently underfunded global health intervention that is already being implemented or could be implemented soon?

In 2004, a World Bank report stated that deaths from malaria could be “all but eliminated” using then available treatment interventions (World Bank, 2004). But ten years later, malaria still kills over 500,000 people every year (World Health Organization, 2014).

One estimate suggested that if use of all the proven effective childhood preventive and treatment interventions were to rise from current levels to 99 % (95% for breastfeeding), the number of under-five deaths worldwide could fall by 63% (Jones, Steketee, Black, Bhutta, & Morris, 2003).

We invest billions of dollars in finding the next vaccine, the next drug, the next possible intervention. But not nearly so much in improving the delivery of interventions we already know work well. These are primarily not scientific or technological challenges. They are challenges of implementation, of delivery.

So what is an example of a delivery intervention we should be trying?

 is a social enterprise founded in 2012. Its key innovation is to use simple vaccine reminder bracelets which are worn by children from birth to age four years old.

Vaccines are highly effective, scalable and have one of the best evidence bases of any intervention in health (according to 

). The number one risk factor in infectious disease is failure to vaccinate (McHugh, Guarecuco, Langer, & Jaklenec, 2015). Yet an estimated one in five children in the world do not receive full or timely immunisation. Vaccines are one of our best weapons against poverty and ill health, yet we aren’t getting them to 

Failure to provide reminders and the forgetfulness of caregivers are key reasons for missed vaccinations across a wide range of contexts (Patel & Pandit, 2011)(Wakadha et al., 2013)(Wilson, 2000)(Quaiyum et al., 2011). Mothers may be illiterate and struggle to understand routine immunisation cards.

 is worn by the child and uses symbols for each disease which are ‘punched out’ when a vaccine has been delivered. The bracelet has been implemented in an initial 6 month pilot study in rural Peru and Ecuador. A bracelet costs $0.10 to produce. Initial results are positive. 91% of mothers said the bracelets helped remind them of vaccination visits. 90% said they would continue to use the bracelets in the future if possible. 87% said they would recommend the bracelets to other mothers. The next step of the innovation is to run a larger 1 year study with 5,000 mothers and babies. Further information is at 

Could this be a viable, practical solution for the challenge of vaccine delivery? Perhaps. We need to test it. Adapt it. Iterate. But this is the sort of innovation needed to get to the 20% of unvaccinated children who are hard to reach.

In Bangladesh, relatively simple innovations such as adding the phone number of vaccinators to immunisation cards helped increase immunisation coverage by 15% in a single year (Save the Children, 2012). Bangladesh is one of the poorest countries in the world but its national immunisation coverage rate (measured using DPT3 rate) is 95% (WHO & UNICEF, 2014). This should be achievable for all countries if the right focus is placed on delivery and experimentation.

The beauty of this Alma Sana vaccine bracelet is that it has the potential to improve service delivery of all childhood vaccinations- an enormous potential impact at a very low cost. Vaccinations are already seen as a ‘best buy’ in public health and highly cost-effective (World Health Organization, UNICEF, & World Bank, 2009).

When considering whether to fund an innovation, we should think about both the impact it could have and the likelihood of achieving that impact. At this stage we cannot say for certain whether the vaccine bracelets will be effective at increasing immunisation rates despite early positive indications. But for approximately $1m this intervention will be rigorously trialled in three different countries to establish whether it works. Given the very low intervention cost even a small improvement in vaccination rates is highly likely to be cost-effective.

Giving What We Can rightly has a focus on what areas are underfunded. As an organisation that can only realistically hope to direct or steer a minority of philanthropic donations this is an absolutely appropriate goal. But Giving What We Can should also consider its comparative advantage when compared to other funding organisations.

Facing a choice between donating to two equally effective organisations, GWWC donors should choose the more obscure, the smaller, less well-known alternative. They are less likely to get the money some other way. Alma Sana is a small social enterprise that has to date received a small grant from the Gates Foundation and some money from a crowdfunding campaign. I do not know their internal financial picture, but it seems unlikely that they currently have the money to fund worldwide trials and they certainly do not have the resources to scale this intervention nationally should it prove successful.

This is where Giving What We Can donors should put their money. Not in the ‘sexy’ development of new drugs, or in the already well-funded, tried and tested rollout of malaria bednets. But in the vital, dull yet risky work of optimising the delivery of proven interventions to make sure they reach everyone who needs them. Alma Sana is an excellent example of the sort of service delivery innovation that is so badly needed.

Jones, G., Steketee, R. W., Black, R. E., Bhutta, Z. A., & Morris, S. S. (2003). 

How many child deaths can we prevent this year? Lancet (London, England), 362(9377), 65–71.

McHugh, K. J., Guarecuco, R., Langer, R., & Jaklenec, A. (2015). 

Single-injection vaccines: Progress, challenges, and opportunities. Journal of Controlled Release : Official Journal of the Controlled Release Society.

Why infants miss vaccination during routine immunization sessions? Study in a rural area of Anand District, Gujarat. Indian Journal of Public Health, 55(4), 321–3.

Quaiyum, M. A., Gazi, R., Khan, A. I., Uddin, J., Islam, M., Ahmed, F., & Saha, N. C. (2011). 

Programmatic aspects of dropouts in child vaccination in Bangladesh: findings from a prospective study. Asia-Pacific Journal of Public Health / Asia-Pacific Academic Consortium for Public Health, 23(2), 141–50.

Blog

Highlights from 2014 - 2015

Where should we donate to do the most good? - Essay Competition 3rd Prize

Where should we donate to do the most good? - Essay Competition Runner up

Reach for systemic change

Where should we donate to do the most good? - Essay Competition Winner

Giving What We Can for People of Faith

Maternal Age Matters: for a lifetime, and longer

Confessions of a Giving What We Can member - how the pledge saves lives

Would you save two strangers or your partner? A review of 'Strangers Drowning'

Reaching for Greater Impact Through US Legislation