Giving What We Can's blog, featuring the latest news from our community.

Stay up to date with Giving What We Can's blog. Featuring the latest news about our community, how to donate effectively, charity evaluation, community events and more!

Blog

footerNavigation

About Us

Contact Us

Our Team

Our Members

Our Events

Our Mistakes

Donate to Giving What We Can

About

Our Best Charities

Take A Giving Pledge

Get Involved

Make A Bequest

Videos, Books, Podcasts

FAQs

Sitemap

Learn more

Press Kit

Media Coverage

Case Studies: People Who Pledge To Give

Media

Footer Navigation

topNavigation

How to give effectively

Why give effectively

Why donate to charity

How much to donate

Anonymous donations

How rich am I?

Can money buy happiness?

Giving

Our recommended causes

Choosing a cause

Global health & development

Improving animal welfare

Safeguarding the long-term future

Advocating for effective altruism

Causes

Our recommended charities

Choosing a charity

Charity comparisons

Charity myths and misconceptions

Charities

Our blog

Our newsletter

Our podcast

Our videos

Videos, Books, Essays

Effective altruism

Resources

Guides

Our members

Team

Contact us

About us

The Pledge

Trial Pledge

Further Pledge

Bequests

Why pledge

Pledges

Share our ideas

Events

Giving Games

Charity Elections

Pledge drive

Careers

Newsletter

Get involved

Community

Donate now

Funds

Tax deductibility

Donate

My pledge

My donations

My income

My impact

Pledge

My giving

Top Navigation

Stephanie Crampin

 on the long-run effects of childhood deworming on children’s performance in literacy and numeracy. The results are positive, and particularly striking, as they tackle some of the key misgivings we have had with deworming as an intervention, and reinforce our confidence in deworming charities as effective investments to combat poverty.

, previous work on the effectiveness of deworming children has relied on a 2004 study on the Rockefeller Sanitary Commission’s campaign to eradicate hookworm in the American South in the early 20th century, and on a series of studies in Kenya. The latter studies arbitrarily selected groups of children to receive school-based deworming, and compared those groups to others which received less deworming treatment. While these increase our confidence in the long term benefits of deworming, there have been reservations about the health and school test results improvements that deworming provides, as well as concerns about publication bias, articulated by Olga Kuznetsova in 

One of the main concerns that we have had concerning deworming has been that, although deworming has been shown to increase school attendance, it was much less clear whether it had any effect on the performance of those receiving the treatment. What this new study shows is that children who had been treated scored better than those in control groups by about ⅓ of a standard deviation, with effects more profound for mathematics than for English literacy. To quote the study, “The effect is robust to a wide range of alternate specifications and inclusion of socioeconomic control variables, and to placebo treatment test. Girlsand children from the poorest income quintiles experience relatively larger gains.”

GiveWell plan to look at this study in more depth, but for now it give us confidence in the efficacy of deworming, and thus reinforces our recommendation of the 

Promising news for deworming

Dominik Diak

Polio cases have decreased by more than 99% over the past 25 years, in part due to the efforts of the Gates Foundation, which galvanized the global community to end polio. Further, the success of India in becoming polio-free provides the last three countries, where polio is still endemic, with optimism. However, political and security reasons have raised difficulties in ensuring that polio eradication will be accomplished by 2018.

Polio is an infectious disease transmitted through contaminated water and food. It attacks the nervous system, leading to paralysis, which may result in permanent disability, and it can be lethal. The lack of a cure and the lack of symptoms of the disease in most cases of infection have made polio eradication an incredibly difficult endeavour.

The first major step towards tackling the disease was made in 1988 when the World Health Assembly launched the Global Polio Eradication Initiative (GPEI) with the aim of eradication of polio by 2000 . At the time, wild poliovirus was endemic in 125 countries and about 350,000 people were paralyzed by polio every year.

The efforts of the global community have been immensely successful, resulting in the Americas being polio-free by 1994, followed by the Western Pacific Region (including China) in 2000, and Europe in 2002. The launch of comprehensive vaccinations programmes played a decisive role in this extraordinary progress.

Since the launch of the GPEI, the incidence of polio has decreased by more than 99%, while the number of countries which remain polio-endemic has been reduced to 3 (Afghanistan, Nigeria and Pakistan).

In 2012, the world recorded the lowest number of reported cases of polio in its history, while India became another polio-free country. Such promising news gave hope that the world’s struggle to eradicate polio might be over in the very near future. However, the final stages of the initiative have been more challenging that it initially seemed, resulting in the announcement of a new six-year strategy: 

The Polio Eradication and Endgame Strategic Plan 2013-2018

Detect and interrupt all polio transmission

Contain polio and certify the interruption of transmission

The example of India gives strong evidence that international efforts (led by the WHO, the Gates Foundation, the Rotary Club and UNICEF) will start to pay off in the near future. India faced many challenges which made the implementation of a comprehensive immunization scheme particularly problematic. These included:

Reluctance of sections of society, in particular parts of the Muslim community, to accept the polio vaccine.

In 2009, there were 741 reported cases of polio in India, more than in any other country in the world, according to the Global Polio Eradication Initiative. This led experts to predict that India would be the last country to stop polio.

‘Micro-planning’ played a major role in bringing India closer towards the goal by making the approach to immunization more systematic. Collecting data about particular places - including areas to be covered by each vaccination team on each day, names of the vaccinators, and of the community workers assigned to the area along with the vaccine - was at 

UNICEF increased the effectiveness of the campaign by setting up the Social Mobilisation Network for Polio in 2001 in the northern Uttar Pradesh state, one of the areas with highest incidence. The workers focused on increasing routine immunization coverage, and promoting habits that reduce the chance of infection (for example, exclusive breastfeeding up to six months, better hygiene and sanitation, and diarrhoea management with Zinc and ORS).

, which protects against both type 1 and type 3 polio, contributed significantly to the good results. However, it was the communications strategy that lay at the heart of India’s victory. Traditionally, a reluctance to vaccinate a child when sick was one of the key reasons for children to miss vaccinations. A 

 showed a rise in the percentage of caregivers willing to vaccinate their child when sick – from 66.6% to 83.3% in Uttar Pradesh (UP) and from 76% to 90% in Bihar, while the percentage of respondents from the high-risk areas (HRAs) of UP who said they had heard negative rumours about polio drops fell from 29.5% in 2010 to 19.1% in 2011.

The Polio Eradication and Endgame Strategic Plan 2013-2018 sets out the strategy to deliver a polio-free world by 2018. The Gates Foundation played a leading role in bringing the global community into action, by pledging US$1.8 billion to this cause at the Global Vaccine Summit in 2013. A group of countries promised another US$ 2.2 billion towards the Strategic Plan’s US$ 5.5 billion six-year budget.

The difficulty of conducting effective vaccination programmes in conflict-ridden areas might turn out to be a difficult obstacle to overcome. In Nigeria, nearly half of the polio cases were located in Borno and Yobe states. Those areas, controlled by Boko Haram, a jihadist organisation, have been difficult to access. For example, during a polio vaccination campaign in May 2013, more than 295,000 children (18% of the under- five population) could not be immunized in Borno. Meanwhile, violent incidents that have taken place since Boko Haram gained control, including 

the death of nine female vaccinators in north Nigeria

, has made it harder to recruit vaccinators.

A similar situation is taking place in Pakistan, where it is estimated that 56 people, including vaccinators and police providing security, have been killed in attacks conducted by tribal rebels since December 2012. A 

 to vaccinate more than 700,000 children fell short of the target by nearly 300,000 children due to inability to deliver the medicaments to unsafe areas of the country. The correlation between insecurity and the recorded number of polio incidences clearly indicates the violence is a major threat that may derail the plan to eradicate the polio by 2018. In 2014, the number of reported cases of polio in Pakistan has already escalated to 160 – the highest number among the last three endemic countries.

Furthermore, the disease has spread to countries which had been polio-free in recent years. The on-going conflict in Syria (which was, 

, free of polio in 2009) has made it one of the countries most threatened by the spread of the disease. It is estimated that vaccination rates in Syria fell from 91% of children before the war to an estimated 68% in 2012. The number is expected to be much lower for rebel-controlled areas, where most of the cases have been reported so far. The efforts to contain the spread of the disease should be at the top of the priority list of the states’ authorities.

To ensure that the recent resurgence of polio will not be a major setback for the campaign, the 

WHO has declared a public health emergency

 and urged the countries which are most likely to export the virus to immunize adults travelling abroad. The results are yet to be seen. However, given the lax border control in many areas where polio has re-emerged, the most straightforward solution is the mobilization to eradicate the virus from the last 3 endemic countries, thus preventing the spread of it to other countries, and finally putting an end to the long battle with polio.

Even if the global community does not succeed in eradicating polio by 2018, the campaign has had an enormous social and economic impact. On top of saving 10 million children from paralysis, the polio eradication campaign has aided the fight against other preventable diseases. For example, National Immunization Days were used as a platform to distribute vitamin A supplements. Meanwhile, the economic benefits of the Global Polio Eradication Initiative, presented in the study 

‘Economic Analysis of the Global Polio Eradication Initiative’

, were estimated at US$40-50 billion, while the provision of vitamin A can have an impact of as much as US$ 90 billion. The latter campaign would not have been nearly as effective if it had not been conducted with the comprehensive polio vaccination schemes. There is potential to replicate the logistical and administrative aspects of the campaign to tackle other preventable diseases.

Endgame for Polio? 

Sebastian Roing

Hillary Clinton, US secretary of state, released a five-point plan in 2012 designed to eradicate AIDS. As soon as more victims are treated than infected every year, an AIDS-free generation should be in sight, given advancements in technology which prevents the spread of AIDS from mother to infant.

How far away are we from the AIDS-free generation? Can we overcome a presently incurable disease with new technology? What are the political problems on the road to the AIDS-free generation? Dozens of articles on the three broad themes of funding, technology and policy have been written on the Guardian development blog over the last three years. This blog post summarises their content.

Before going into the material from the Guardian, please note that you can find a list of relatively effective HIV/AIDS interventions and the problems they are tackling at the bottom of this post.

The big event shaking the development community over the last three years was the decision of the Global Fund to fight AIDS, Tuberculosis and Malaria to cancel its funding round in 2012. Essentially, the two big factors behind it seemed to be lack of funding from European countries shaken by the Euro-crisis, and a decreasing interest in the cause. There seemed to be a widespread rationale amongst policy makers of “so much funding has gone into HIV/AIDS over the last 10 years, aren’t we pouring disproportionate amounts of money into this cause?”.

The Global Fund has had a huge impact over the last ten years. Take Malawi as an example. In 2012 it had managed to put 76% of all those who need it on treatment, most often antiretrovirals. Malawi got more than 90% of its funding to combat AIDS from the Global Fund. The health system of Malawi really hinged on resources from the Global Fund. Around the globe, the fund supported programs in over 140 countries in 2014. These programs had 6.6 million people on antiretroviral therapy for AIDS, have tested and treated 11.9 million people for TB, and have distributed 410 million insecticide-treated nets to protect families against malaria.[1]

So the Global Fund's decision to cancel its funding round in 2012 had huge significance for countries like Malawi. People living with HIV are dependent on antiretroviral treatment to stop the infection from developing, and to hinder the development of AIDS. Furthermore, someone infected by HIV is 96% less likely to transmit HIV to his/her partner if on a standard combination of antiretroviral drugs.[2] Discontinuing treatment would therefore not only fail our responsibility to those on treatment, but it would also put the AIDS-free generation at risk by increasing the spread of HIV.

Fortunately, the Global Fund is back on track, as shown in the figure below. A good point to take from this would probably be that other causes remain underfunded, or at least less well funded than the fight against AIDS. This suggests that individual donors can have more impact within other causes, such as intestinal worms and Malaria. Find out more about some of the most effective charities 

Figure 1: The Global Fund Annual Disbursements 2002 - 2013 [3]

Are we moving towards a cure for AIDS? Sadly, no. The only person ever to have been cured of HIV had a bone marrow transplant from another person who was resistant to HIV. This is a prohibitively expensive procedure. However, we have many reasons to celebrate a few advances that occurred over the last few years.

The WHO started recommending giving antiretroviral drugs to everyone with HIV since this has been shown to limit the spread of the disease to uninfected people. In fact, the WHO reported that increased access to HIV services, such as antiretrovirals, resulted in a 15% reduction in new infections over the past decade, and a 22% decline in AIDS-related deaths over the last 5 years.

Both UNAIDS and Medecins Sans Frontieres were very positive about the recommendation. This advancement opens up new possibilities for effective interventions in combatting the spread of HIV. This advance might even open up opportunities for individual donors to have significant impact. If we could finally get the rate of HIV infection to reach zero, then the AIDS-free generation becomes a very tangible goal.

An interesting application of antiretrovirals as preventive treatment is a vaginal ring which works by disseminating the antiretroviral drug into the tissues of the vagina. A major trial of this was launched in Africa in 2012. One advantage of the ring is that it’s safe to use a higher dose of the drug than could be taken orally, without the toxic effects. It should also be possible to combine the ring with hormonal contraception. Some studies have suggested that hormonal contraception increases the risk of HIV infection.

New technological advances have also been made in tests for the stage of HIV. A new machine called “the Samba machine” has lowered the cost of one viral load test from >£25 to £10 per test.

The Samba machine is also much quicker. Instead of having to wait for over three months, a person in rural parts of Malawi can now have the test results in an hour.In terms of follow-up, this means a lot. Hospitals have previously reported that people never show up for their test results, and thus that treatment was never distributed. Additionally, the disease may well have progressed over three months, leading to the hospital distributing the wrong kind of antiretroviral drugs.

The Samba machine therefore promises more effective interventions in the future. WHO says viral load testing, which detects the level of HIV virus in the blood, is the best way to monitor the effects of antiretroviral treatment.[4]

A few significant political developments have shaken the development community over the last few years. The most significant one, perhaps, was the reversal of the US anti-prostitution pledge in 2013.

The anti-prostitution pledge requires NGOs that receive US federal anti-HIV/AIDS or anti-trafficking funds to adopt organisation-wide policies opposing prostitution. The Obama administration had previously been divided on the issue, with the President declaring that a reversal was necessary in 2010, but later reverting on this statement. The pledge was finally abolished in 2013 by the Supreme Court on First Amendment grounds.

The reversal means that funds can now reach sex workers and other people in very vulnerable situations, and should thus be seen as a humanitarian victory. You can find a very good article on empowerment and community for sex workers in India 

A negatice development is the continued distrust of western health workers and doctors in developing countries. We find an particularly relevant example of the risk of mixing foreign policy and healthcare in Pakistan. CIA operatives disguised themselves as polio vaccinators to gain greater access to Osama bin Laden’s compound in 2011. While the mission achieved its goal, it later led to reversals in local efforts to eradicate polio.

Special attention to this problem has also resulted from the outbreak of Ebola. There seems to be a good cause to ignite a debate of whether to keep public health services, security services and foreign policy separate.

Big Pharma and other commercial giants have also been the stuff of headlines in the context of the struggle against AIDS. Coca-cola started a big collaboration with the Clinton Foundation and the government of Mozambique to speed up distribution and improve storage of medicines and tests. Some people in the development community met this collaboration with scepticism.

Additionally, GloxoSmithKlein (GSK) partnered up with Save the Children to speed up delivery of antibiotics and other medicines to children. Some philanthropists remain uneasy about the collaboration given GSK’s past actions and Medecins Sans Frontieres have stressed that GSK still needs to make antiretrovirals and other medicines truly cheap in poor countries. Nevertheless, this project in particular should be a step forward in the fight against under-5 mortality.

The control of HIV/AIDS usually includes the use of multiple antiretroviral drugs, aimed to control the HIV infection. There are different stages of the HIV-cycle, and different drugs need to be used at different stages. Antiretroviral treatment maintains the functioning of the immune system, decreases the patient’s total burden of HIV and prevents the opportunistic infections that often lead to death. It is estimated that antiretroviral therapy saved 700,000 lives in 2010 alone [5].

According to some scientific studies, though importantly not all, male circumcision can reduce female to male transmission of HIV by 60%. Male circumcision is seen as a cheap way to fight AIDS in Zambia. Given its low cost and purported effectiveness, donors have started pushing it as a prevention strategy. However, some fear that it could discourage condom use.

Condom use has been pushed as a very effective measure to prevent the spread of HIV. It’s cheap and it’s effective. However, the success of mass campaigns for the use of condoms varies and such campaigns are largely out of fashion. The very effective “Take control” campaign in Namibia was discontinued in 2011. Interventions to increase condom use may still be very cost-effective.

The Guardian: HIV/AIDS: We are all unprotected

The Guardian: Samba Machine a welcome boost for people living with HIV in rural Malawi

An AIDS-free generation? A summary of the discussion held on the Guardian Development Blog

Olga Kuznetsova

Although there is increasing awareness of the need to combat neglected tropical diseases, 

NTD control programs are often still underfunded

. Consequently, donors are encouraging new solutions that would make the most efficient use of resources.

Luckily, such solutions are possible, and they rely on the fact that 

the distribution and treatment of different NTDs are often quite similar

. NTDs such as schistosomiasis, soil-transmitted helminthiasis (STH) and lymphatic filariasis are often found in the same geographical area, and their treatment involves mass administration of safe drugs. Combining, or integrating, the treatment of several NTDs would therefore reduce costs and allow wider coverage. This article is based on the talk given at the 2014 Schistosomiasis Control Initiative Open Day by Dr Anna Phillips, and describes how the SCI is participating in NTD control integration.

“Integration” can mean different things, depending on the context. One type of integration is when drugs against several diseases are administered to the same community at once, usually under an “umbrella” program that oversees the work of individual NTD programs. Alternatively, preventative chemotherapy can be integrated with other sectors, such as water, sanitation and hygiene (WASH). Finally, drugs can be distributed in “community-based integrated delivery”: not as a stand-alone program but through existing health and education structures. Each of these will be discussed in turn.

In 2007, a grant from the U.S. Agency for International Development (USAID) allowed the SCI to 

integrate national schistosomiasis and STH control programs with lymphatic filariasis and trachoma

, in areas where these diseases overlap. SCI’s role is to work with Ministries of Health (MoHs) of its target countries to provide support and funding. As a member of country specific NTD Task Forces SCI, the MoH NTD Committee, the World Health Organisation, NGOs, funders and programme managers from each of the individual NTD programmes, work together to provide technical support for integrated staff training, drug storage and delivery, sensitization and education, and MDA across several NTD programmes. This results in considerable cost savings and multiple drug administration for the treatment of several NTDs becomes possible.

A specific example is the triple drug administration that the SCI is carrying out in parts of Mozambique, where the population is simultaneously treated against lymphatic filariasis, STH and schistosomiasis Integrated MDA is still in its infancy and not as yet fully endorsed by the WHO.

Integrating the delivery of several drugs comes with its challenges. Increased workloads for already overburdened staff, possible power struggles between the different NTD programs, and delays to the supply of one drug can set back the treatment of other diseases.Making the treatment more efficient could also result in less funding for NTDs in the long run.

multiple drug administration has the benefit of saving costs and time compared to running separate NTD programs

. For instance, the community advertisement and sensitisation is reduced to just one campaign, freeing up resources to be used to expand coverage.

In its 2010 Report on Neglected Tropical Diseases, the WHO outlined the strategies necessary for NTD elimination. Because multi-drug administration (MDA) alone is not enough to break the disease cycle, the WHO highlighted a need for “complementary interventions”: in addition to chemotherapy, it is recommended to implement vector control and improve WASH and veterinary health [1]. This makes sense because several diseases, such as schistosomiasis, trachoma and STH are transmitted as a result of poor water, sanitation and hygiene. Likewise, eliminating parasite vectors such as mosquitoes and molluscs can be integrated into existing disease control programs.

Although such interventions are expensive to implement, they carry significant cost-benefits in the long run. However, their success depends on sufficient funding, integrating the different skills across sectors, successfully coordinating different interventions, as well as reducing damage to the environment when insecticides or molluscicides are used.

The idea behind community-based integration is 

using existing structures within the community

 to deliver NTD treatment services. This can include drug administration within school feeding programs or during mother-to-child health days. As the drugs used to treat NTDs do not require refrigeration and can be administered after receiving a short training, delivering NTD programmes through the community is viable, increases coverage and reduces costs significantly.

In 2003, the WHO suggested a paradigm shift in the response to global health needs. This new approach would 

integrate NTD control to make sure the money and resources are used in the most efficient way possible in the battle against poverty and disease

. Since then, organisations such as the SCI have been putting this into practice by integrating different NTD programs to deliver combined treatment, or more comprehensive control of individual diseases. Despite a number of challenges, integration is one of the most efficient ways to bring us closer to NTD elimination.

WHO Report on Neglected Tropical Diseases

Talk by Dr. Anna Phillips at the SCI Open Day 2014

Integration of neglected tropical disease control - how to eliminate schistosomiasis on a tight budget

Giving What We Can

Despite the economic growth of emerging countries over the past years, quality of life has not been improving proportionally in every country. 

 lies at the heart of this issue by depriving the states of the desperately needed financial resources. In this post, we will look at the issue of broad-scale corruption and how it affects the progress of developing countries. You can read about the related issue of small-scale corruption and how it impacts international development organisations 

the movement of assets or money out of a country or region

, as when foreign investors decide to withdraw capital from a country as a result of an event of political or economic significance; or illegal, in the form of illicit financial flows (IFFS). The 

increase of illicit financial flows (IFFs)

 is a pressing issue for many developing countries. The sheer scale of the problem is striking when estimates of capital flight are put side by side with the amount of foreign aid flowing into Africa, and the countries’ debts. 

Capital flight is estimated to be 10 times the annual foreign aid flow

 and twice the amount of the debt being repaid by the emerging countries every year.

Peter Reuter’s report on IFFs, 'Draining Development?'

 depicts how capital flight has impacted on the social development of the emerging countries. Corrupt heads of state illicitly move state funds, very often received from developed countries, international development organisations or NGOs, into their private accounts to enrich themselves.The stories of Sese Seko of Zair, who is believed to have amassed more than $4 billion, or General Sani Abacha of Nigieria who looted the Nigerian Central Bank stealing nearly $2 billions, are just the tip of the iceberg.

Capital flight has a strongly negative effect on the economy, as 

capacity to finance social services and other public investments is greatly eroded

 due to such drains on the resources. Moreover, 

the tax burden is being shifted on the middle class and the poor

 who effectively have to subsidize social services due to tax evasion- a form of capital flight - by high-earning organisations.

It is undoubtedly true that not all of the state revenue which would have been accrued by curbing money launderings, IFFs and the like would be channelled into priority areas (such as education or health). Nevertheless, 

 if, for example, the same proportion of the tax revenues had been spent on health care since 2000, with the added tax revenue from avoiding capital flight, the lives of 350,000 children could have been saved every year. Furthermore, given the high correlation between corruption, IFFs and money laundering, it could well be that the attempts to tackle capital flight would have a spillover effect on other problematic areas.

Illegally acquiring public funds that would have been spent on running the country is the direct corollary of pervasive corruption scandals in Africa. Another strongly negative effect of capital flight is 

undermining the belief of people in the developed world in the effectiveness of foreign aid

, reducing their willingness to donate. The multitude of stories about flamboyant political leaders, immune to the rule of law, the example being the son of Equatorial Guinea’s leader who was granted the position of a vice president to obtain immunity, provides the critics with ammunition to substantiate their view of foreign aid as a futile endeavour.

However, such a conclusion is misguided: the fact that some aid is misused does not mean that aid has little or no impact. In fact, the many success stories in international aid and the improvement in living standard across the developing world over the past decades show that 

. Further, we can increase the impact of our donations and avoid the impact of corruption by 

, to charities with a proven track record of 

Blog

Promising news for deworming

Endgame for Polio?

An AIDS-free generation? A summary of the discussion held on the Guardian Development Blog

Integration of neglected tropical disease control - how to eliminate schistosomiasis on a tight budget

A Look at Capital Flight from the Developing World

Tuberculosis: The Potential for Cost-Effective Intervention

Donating in the face of corruption

Open Philanthropy Project: looking at hard questions on how to do good

Female Genital Mutilation: what is the problem and what can be done?

Eight ways you can use your time to improve the world