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 values

Our members

Our events

Transparency

Our mistakes

Our impact

Donate to Giving What We Can

Careers

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

Recommended charities

High-impact causes

Why give to funds

How much to donate

Why donate publicly

Recommendations

Comparing charities

Choosing a cause

Inclusion criteria

Trusted evaluators

Our approach

Videos, books, podcasts and essays

Myths and misconceptions

How rich am I?

Can money buy happiness?

Resources

Research

Team

The Pledge

Trial Pledge

Further Pledge

Bequests

Why pledge

Pledges

Newsletter

Podcast

Videos

Sharing our ideas

Events

Giving games

Charity elections

Pledge drive

Fundraisers

Community

Donate now

Best charities

Manage my donations

Tax deductibility

Donate

My pledge

My donations

My income

My impact

Pledge

My giving

Top Navigation

Olga Kuznetsova

In 2012, the World Health Assembly declared that elimination of schistosomiasis is feasible. It urged to speed up control and elimination programmes, and called on the World Health Organisation to guide member states in their efforts [1]. In line with its vision of “a world free of schistosomiasis”, the WHO put together a Schistosomiasis Plan, with the end goal to eliminate it as a public health problem by 2025, and to interrupt transmission in many areas by the same time. The Schistosomiasis Control Initiative has already carried out successful campaigns in several African countries, but there is still a while to go before complete elimination takes place. This article summarises the talk given by Dr. Michael French at the SCI 2014 Open Day, and discusses what needs to be done to eliminate schistosomiasis and what the SCI is doing to reach this goal.

Before we continue, we need to define what exactly is meant by “elimination”. At the moment, SCI’s efforts focus on controlling the disease morbidity and eliminating it as a public health problem, i.e. reducing the prevalence below a certain threshold, say, 1%. However, to achieve true elimination, transmission of the disease within a particular area has to be interrupted. For this, the disease has to fall below the “transmission breakpoint” – at which the level of infection is so low that it will inevitably die out. Elimination is then a less ambitious goal than eradication, i.e. bringing all the worldwide cases to zero, as has already been achieved for smallpox and nearly achieved for guinea worm and polio. For the moment there is no goal to eradicate schistosomiasis. For the rest of the article we will be talking about elimination of transmission.

So what is necessary to achieve elimination of schistosomiasis? For its past and ongoing projects, SCI used preventative chemotherapy (PCT) with praziquantel to control disease morbidity. However, more intensive measures are needed for elimination. In areas with a high burden of disease, children as well as adults in high-risk occupations are treated every year. However, even if there is a sharp drop in infection following treatment, there is still a certain amount of infection left in the population (indicated by the red double-headed arrow in the graph), and it is enough to allow re-infection during the year. With subsequent yearly PCT, indicated by green arrows, the number of cases drops but never quite falls below the transmission breakpoint.

What if instead it were possible to bring the infection close enough to zero from the very first round of PCT? In the long run, it would save a lot of time and resources. Because closing this gap will almost certainly require more than just PCT, a combined approach maximises the chances of interrupting transmission. For example, there are measures that could prevent infection in the first place. These include improvements in the quality of WASH (water, sanitation and hygiene), snail control (as snails are the intermediate host of the worms), behaviour change with an impact on water contact, and more novel approaches such as development of vaccines or new drugs.

To assess the effectiveness of preventative measures, work is being undertaken at Imperial College to explore the link between WASH and schistosomiasis infections. There are also randomized controlled trials carried out in Zanzibar and Burundi/Rwanda, with several arms of the trials analysing the effectiveness of snail control, enhanced treatment and improved WASH, in addition to the current chemotherapy. Another line of research is looking into vaccines. At the moment there are none commercially available, and even if the candidate compounds currently in clinical trials make it to the market, it will not be for several years. Successful vaccination depends on many factors, and the SCI are developing mathematical models to define which factors would make for optimal protection (e.g. what cross-section and proportion of the population to vaccinate, which life cycle stage of the worm to target, and the level of vaccine efficacy). All in all, these complementary approaches may help to eliminate schistosomiasis, but they are difficult to implement and in some cases not yet available.

What else can be done to improve treatment? One obvious idea is just to reach more people. At the moment no population receives 100% coverage with PCT. Although drugs are in plentiful supply, with millions of doses donated every year by pharmaceutical companies, treatment can be held up by problems with shipment and transportation of drugs within the target country. To address this problem of logistics, a coalition of pharmaceutical companies, logistics companies and NGOs have formed the NTD Supply Chain Forum. The Forum’s main task is ensuring that the drugs clear through customs and reach the national warehouses on time. Another potential solution is inspired by an unlikely company - Coca-Cola. In 2009, a collaboration began that started from the simple question: if Coca-Cola can be delivered to anywhere in the world, why not life-saving medicines? A partnership between Coca-Cola, the Gates Foundation and the Global Fund resulted in Project Last Mile. The Project uses Coca-Cola’s supply chain and logistics to deliver drugs against AIDS, tuberculosis and malaria to ten African countries. At the moment it is not used for drugs against schistosomiasis, but that is an avenue to be explored.

Another option is to re-consider which groups within the population receive treatment. Historically, schistosomiasis control programs have focussed particularly on school-age children, as PCT protects them from the consequences of infection later in life. Indeed, when looking at the infection profile across different age groups, the highest intensity of infection is normally in school-age children and young adults, as shown by the red “baseline” in the graph below. It is assumed that pre-school children suffer only light infection, but in fact there are very few data points to back up this assumption. By not including the very young children in the treatment group, a significant amount of infection may remain in the population. After a round of treatment (F1, blue line), the infection drops with high levels remaining only in the youngest children who were not treated. These levels, however, may be high enough to affect the rest of the population.

SCI are now researching how young children impact on worm transmission to develop better strategies to treat everyone at risk. Furthermore, a collaboration of several companies including Merck is already developing a paediatric formulation of praziquantel that could be given to pre-school children.

Although much progress has already been made by the SCI to combat schistosomiasis, further work requires novel approaches and a better understanding of the disease. For some types of interventions it would require collaboration with other sectors, particularly when the task is outside SCI’s area of expertise. And finally, the basics such as delivering PCT and ensuring wide treatment coverage would need to continue to a high standard, or even improved. Taken together, these approaches may finally bring us towards the elimination of schistosomiasis.

Slides from Dr. Michael French’s talk at the SCI Open Day 2014

Can schistosomiasis be eliminated? Lessons from Coca-Cola and other stories.

Carolina Flores

Shocking images of starving children are one of the staple images of extreme poverty. But childhood malnutrition is not limited to such extreme hunger: in fact, millions of children appear normal but are chronically malnourished. The problem of hidden hunger extends widely and has got serious consequences.

Hidden hunger includes both low weight for age (excluding acute malnutrition, which cannot be considered hidden), and micronutrient deficiency, which is very often associated to low weight for age. The scale of the problem is huge: one out of six children in developing countries is underweight, that is, 

What are the consequences? To start with, 

 children still die of malnutrition every year [2]. The picture is bleak: a shocking 45 [3] to 

 [4] of childhood deaths worldwide are attributable to under-nutrition. Hunger remains the biggest killer of under-five children. Furthermore, malnourished children are both more likely to contract diseases and to die from them. Of childhood deaths from disease, the following percentages can be attributed to under-nutrition [5] :

52.3% for pneumonia – 1 000 000 children

It is important to note that this is not limited to children who are extremely underweight. Though the effect is more pronounced in such cases, if we combine the risk associated with moderate malnutrition with its high prevalence rates, we find that much of the burden of deaths as a result of under-nutrition in young children is attributable to moderate, rather than to severe, malnutrition.

But perhaps the most invisible form of hunger is micronutrient deficiency, which, though not even necessarily associated to low body weight, can seriously reduce span and quality of life. These are some of the consequences of particular micro-nutrient deficiencies [6]:

As for the economic consequences of hunger, start by noticing that it is the main factor in causing childhood stunting, which affects a quarter of all children worldwide [7]. This has got consequences to motor and cognitive development, and to educational achievement, which in turn reduce productivity in adulthood. This and the increased health costs it causes make hunger a heavy burden on the economy. Under-nutrition and micronutrient deficiency cost up to 

 to the global economy [8], and it is estimated that childhood malnutrition costs USD25 billion a year to Africa alone [9]. In contrast, it is estimated that addressing childhood and maternal hunger worldwide would cost only USD10 million [10].

There has been some progress in reducing hunger over the last decades, with the number of undernourished people having decreases by 17% in the last two decades [11] but this is widely acknowledged to be unsatisfactory. For example, the stunting of early childhood growth as a result of malnutrition has decreased only 1% [12] in the last two decades. In comparison, TB cases have declined by 40% [13], and malaria cases by 30% [14]. Also, the improvements there have been are unevenly distributed geographically: for instance, in North Africa and South Asia the improvements have been modest, and in West Africa, the situation has actually worsened [15].

Solving this problem will have to involve agricultural partners, governments, and NGOs, and will likely require economic growth and improved social policy in the affected countries. As components of a solution for this problem, the following have been suggested [16]:

create more nutrition-sensitive programmes that include small farmers and families

increase women’s control of land ownership and farming decisions

widen access to agricultural credit and subsidies to encourage domestic food production

focus more on the energy supplements to pregnant women. In the Gambia, an intervention of this type lead to a 39% reduction in low birth weight cases, one of the important reasons for low body weight for age later on in childhood, and a 40% reduction in infant mortality [17].

Assessing the cost-effectiveness of interventions in these areas is possibly worth investigating. But for now the best opportunity for effective giving to target hidden hunger is micronutrient fortification, as Giving What We Can has acknowledged in recommending Project Healthy Children [18]. Adding important nutrients such as folic acid, iodine, iron, vitamin A, and zinc to staple foods is very cheap, at just a few cents per year per person, and greatly contributes to eliminating the problems caused by micronutrient deficiency. The Copenhagen Consensus has estimated that every UDS1 spent on food fortification results in USD9 benefits to the economy [19].

Micronutrient fortification is not a complete solution to the problem of hunger, but it seems to be the best place to start. The problem has a large scale and, when we consider the suffering it causes, much more should be done to alleviate it. Hidden hunger needs to be brought to light and approached integrating economic and agricultural policy, education, and large-scale health interventions like micronutrient fortification. If you want to start making a difference today, you can donate to Project Healthy Children 

Undernutrition as an underlying cause of child deaths associated with diarrhoea, pneumonia, malaria, and measles

FAO: Understanding the true cost of malnutrition

Voa News: Unicef on the cost of Africa's child malnutrition

Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

WHO: Prevalence and trends of stunting among pre-school children, 1990-2020

Project Syndicate: Africa's hidden hunger

What works? A review of the efficacy and effectiveness of nutrition interventions

Giving What We Can: Project Healthy Children

Project Healthy Children: Food fortification overview

The World's Hidden and Deadly Hunger

Angelina Li

This article is part of a series of regular updates on the Against Malaria Foundation. Most of the information for this article has been taken from the 

 where you can find out more about this organization. If you would like to donate, you can do so 

The Against Malaria Foundation is one of the leading anti-malaria foundations worldwide, and funds the purchase of long-lasting insecticidal nets which are then distributed to areas of need. The organization has been widely commended for its adherence to many of the principles of effective altruism - for instance, AMF emphasizes cost-effectiveness, transparency and a demonstration of impact in its guiding principles[1].

Last month, the Against Malaria Foundation reached its 93,000th donation - as shown below [2]

Further, the Against Malaria Foundation is scheduled to distribute long-lasting insecticidal nets in Kasaï Occidental in the Democratic Republic of Congo and in the Dedza District of Malawi in the near future.

The first distribution in Congo (Dem. Rep.) has been scheduled to occur between July and October of 2014. This proposal is currently in its distribution stage, where on-the-ground distribution of the nets involved will occur in co-operation with local authorities and relevant NGOs. The organization IMA World Health is partnering with the Against Malaria Foundation in order to distribute the 

 involved. This project was funded by 2,737 separate donations, and cost a total of USD$1,943,850 to fund.[3] This will be one of the biggest distributions scheduled for 2014 by the AMF.

The next distribution in Malawi is scheduled to occur during September and October of 2014. This proposal is still in its pre-distribution stage: a Pre-Distribution Registration Survey is being conducted in order to determine how many nets are needed by the region to ensure that all sleeping areas will receive anti-malaria protection. Once in its distribution stage, the nets will be distributed by Concern Universal, an international development organization that will help distribute around 

 on behalf of the Against Malaria Foundation. This project was funded by 1,274 separate donations, and cost a total of USD$738,800 to fund.[4]

This shows that the AMF is continuing to make serious contributions to alleviate extreme poverty through its bed-net distribution projects. Just these two distributions are estimated 

! [5] Stay up to date on the Against Malaria Foundation's activities at their 

Give Well Estimates of Cost-Effectiveness of mass distribution of bed-nets (LLINs)

Against Malaria Foundation: August - September Update

Jessica Costello

This post is part of a monthly series of updates on Evidence Action. The one about progress in July can be found 

. You can find this and more information in their 

Last month, Evidence Action’s Deworm the World Initiative and the Government of Kenya announced the results of the second Kenya National School-Based Deworming Programme. This was the largest deworming exercise ever conducted in the country, targeting soil-transmitted helminthes (STH, common worms) and schistosomes (which cause bilharzia).

The programme was highly successful, and national targets were surpassed!

Notably, more than 6.4 million children were successfully dewormed, exceeding the target of 5.7 million children by 12%. After two successful rounds of treatment, the prevalence of STH dropped from 33% in 2012 to 6% in 2014 in 20 observed sub-counties.

More than 890,000 children were also treated for schistosomiasis, exceeding the national target of 600,000 children by 33%.

Deworming took place in nearly 16,000 schools in 28 counties that are endemic for parasitic worms, again exceeding the target of 11,000 schools. Further to this, 143 Sub-Counties successfully implemented deworming, out of 144 Sub-Counties planned for; 28,248 teachers were trained to administer deworming tablets to children, and 3,534 Sub-County and Ward personnel from the Health and Education ministries were trained in successfully implementing deworming.

This is great news, because school-based deworming is proven to be an effective intervention with tangible health, education, labour productivity and earnings benefits, and is one of the most cost-effective methods of increasing overall school attendance and participation.

The success of Evidence Action’s Deworm the World Initiative in achieving its goals was recognized by Ezra Klein from Vox Media, who donated to Deworm the World as part of the 

EvidenceAction thanked him for his support by 

Overall, it's well worth celebrating the success of Evidence Action’s Deworm the World Initiative across Kenya, which surpassed its initial goals. It is also good to see the enthusiastic public support it has garnered!

Evidence Action - August Update

Peter Hurford

Relatively wealthier countries certainly spend a lot of money on developing world [1] aid. But how much money is being moved? And by whom? If we’re interested in understanding and influencing aid spending, it’s important to know how it’s distributed and where it comes from.

Figure 1 shows spending on public health and public education, as well as money moved by Official Development Assistance [2], charitable giving, remittances (money sent back home by migrant workers), and foreign investment (money invested in developing world companies).

The green and orange columns refer to spending (either in aid or from the governments themselves) in Low Income Countries (LI) [3] and Lower Middle Income Countries (LMI) [4] respectively. The red column refers to spending in higher income countries and is available for Official Development Aid (ODA) data, but not for any of the others. Blue columns are columns for which information on income is unavailable.

Data reported in the first three columns refer to year 2011 (most recent comparable year). Data in columns four, five and six from ‘The Index of Global Philanthropy and Remittances 2012’ refer to the year 2010. They are expressed in current USD and thus are not adjusted for Purchasing Power Parity (PPP).

PPP is a ratio that expresses the amount of good or services that one USD can buy in different countries which makes the figures comparable even if they are spent in different places. However, at the present time data required to do this adjustment were not available. Note that figures in USD will tend to underestimate the real value of the services provided in the poorest countries because services like education and health cost less to provide there.

Overall, in 2011, spending on public health was $92bn and spending on education was $231bn. Significantly more money was spent in LMI countries than LI countries. This is because much of the money in public health and education is spent by the countries themselves, and LMI countries have more money to spend -- with higher GDP per capita and, in the case of India, enormous population.

ODA is defined as disbursement of loans and grants made on “concessional terms”, or terms at which the ODA nations will overall lose money and don’t stand to gain any profit [5]. For example, ODA assistance must include at least 25% in grants (money given with no expectation that it be later returned).

ODA has provided $134bn in aid over 2011, of which $42.6bn went to LI countries and $37.3bn to LMI countries. ODA spending is therefore larger than spending on public health in LMI and LI countries and furthermore is the majority of all spending in LI countries. However, as described in the Department for International Development report “Aid for the Poorest?” [6], ODA does not focus on the poorest countries as much as one would expect.

Research from The Center for Philanthropy at Indiana University [7] found that the United States represents the largest charitable sector in the world, at least in terms of absolute amount of dollars given. About 2% of US GDP was donated, representing $298.42B. However, according to this report, only 8% of this total, or around $22.68B (8% of donations), went to “international causes”, with 32% of donations being given to religious charities, 13% given to education in the US, 8% to health in the US, 3% given to environmental and animal organizations, and 36% being given to other causes.

Another report from the 2012 Index of Global Philanthropy and Remittances [8] calculated that the US actually spends $39bn on the developing world, with 36% coming from private and voluntary organizations, 19% coming from corporations, 18% coming from religious organizations, 12% coming from foundations, 10% coming from volunteering, and 5% coming from universities and colleges.

Remittances are transfers of income across borders, sent back home by friends or family working abroad. They are a very significant source of cash flow into the developing world - at $190bn, they represent more than six times charitable spending.

This can be seen as an argument for the importance of opening up opportunities for migration in order to get more money into the developing world. Unfortunately, the poorest of the poor are unlikely to be able to migrate and therefore will never benefit from remittances, so this cannot be the complete solution for poverty.

The largest flow of money into the developing world was investment in developing world companies from foreign investors, topping out at $329bn. This was not always the case, and can arguably be read as a hopeful sign for the future economic growth of developing countries.

Overall, breaking down the spending in the developing world has interesting implications for foreign aid. When we imagine the trillions of dollars in aid money that have been spent over the past half century, we don’t really imagine that not all that much of it is going to those who need it the most -- the poorest of the poor. This shows that, from a humanitarian perspective, there is plenty of potential to improve investment in the developing world.

But, perhaps most importantly, it shows the scope of charitable giving. There isn’t a whole lot of giving to the developing world relative to the total amount of charitable giving. But it still stacks up quite well, being only less than half of ODA. Thus, charitable giving has an important role to play. And we should continue to shape this role by encouraging more, and more effective, giving to the developed world.

World Bank: Lower Middle Income Countries

The Index of Global Philanthropy and Remittances 2012

Where is the money in development spending?

Stephanie Crampin

This article is a summarised form of an upcoming report by Josh Goldenberg on the topic of blindness. Keep an eye out for when the report is published for further details of this area.

Blindness and visual impairment are significant issues worldwide, causing loss of employment, self-esteem and productivity. The most recent estimates from PwC state that 32.4 million people worldwide are blind, and 190.6 million suffer from low vision. Out of these, 1.4 million children are blind, and 19 million visually impaired. This is down from the 37-38 million people living with blindness in 1990, suggesting progress, and a rapid decline in blindness rates.

90% of visually impaired people live in the developing world, in large part their blindness caused by easily preventable conditions such as trachoma-induced cataracts and river blindness caused by blackflies. An astonishing 80% of visual impairment in the world could be prevented by good hygiene and basic medical care. This makes blindness an attractive candidate when looking for a particularly effective charity.

PwC estimated that it would take $392bn (on top of the current $5.9tn) from 2011-2020 to eliminate avoidable blindness entirely, though only $128.2bn to eliminate avoidable blindness in the low and middle income countries. 

, for the cost of one guide dog, over a thousand surgical treatments for trachoma could be provided. But does this yield any specific steps we can take to make an impact on blindness? Below is what you need to know.

Cataract is responsible for at least 33% of global visual impairment and at least 51% of global blindness, according to the WHO. It is clouding of the lens of the eye which prevents clear vision. Overall, the cost-effectiveness of surgery in the South Asia region has been estimated at about $60 per disability adjusted life year, and an analysis of the current literature on cataract prevention suggests that the most likely figure is somewhere around $40-150, with $90/DALY around the median of each of the estimates, a figure promising enough to be worth investigating further.

Despite the very promising numbers, cataract treatment requires a lot of factors to be in place before it can start to be effective. A lot of training is required for the surgeons who carry out the treatments, as well as assistance from health providers, and education if the community to dispel fears of surgical treatments. Compared to deworming, it requires a much greater investment of time and money, but fewer people are needed, and surgeries need only be administered once, rather than yearly.

Although we can’t be confident that donating to combat cataracts is as effective as donating to our top charities, it is likely that it will be a very effective investment.

Trachoma is the result of infection of the eye with Chlamydia trachomatis. If the infection is left untreated and the eye is re-infected, it can cause the eyelid to turn inwards, meaning that eyelashes come into contact with the eye, causing scarring, immense pain and eventually irreversible blindness. The WHO recommended strategy for combatting trachoma is ‘SAFE’ – surgery, antibiotics, facial cleanliness and environmental changes.

Despite the multifactorial approach recommended by the WHO, surgery is the best investment for donors at the moment, as it is not subject to the same limitations as the other factors: Antibiotics are mass-distributed, facial hygiene interventions involve mass education, and environmental change involves large projects, such as improving sanitation. Funding surgeries has the potential to make way for many future operations (such as hospital building) and it is also a necessary part of an eradication programme.

A 2012 WHO article on the situation of trachoma paints a positive picture on the current state of affairs regarding this disease. From the 53 countries that are endemic in blinding trachoma:

28 reported data on implementing the SAFE strategy.

6 countries reported that trachoma was no longer a public health problem in 2012 (<0.1% suffer from trichiasis, <5% of 1-9 year olds suffer from active trachoma).

The number of people living in trachoma endemic districts reduced from 317m in 2010 to 241m in 2012 – almost a 25% decrease in just two years.

48.8 million people received antibiotics.

169,000 trachoma surgeries were carried out.

A 2006 estimate also stated that the number of people affected by trichiasis fell from 360m in 1985 to just 80m in 2006. So great progress is being made.

Onchocerciasis is responsible for 0.8% of global visual impairment (1.5 million) and 4% of blindness (0.6 million). It is also regarded as particularly painful and debilitating. To quote the WHO’s pleasant description:

“Onchocerciasis is a parasitic disease caused by the filarial worm Onchocerca volvulus. It is transmitted through the bites of infected blackflies of Simulium species, which carry immature larval forms of the parasite from human to human. In the human body, the larvae form nodules in the subcutaneous tissue, where they mature to adult worms. After mating, the female adult worm can release up to 1000 microfilariae a day. These move through the body, and when they die they cause a variety of conditions, including blindness, skin rashes, lesions, intense itching and skin depigmentation.”

Cost effectiveness estimates range from 4 to 130 $/DALY. More work is needed to come to a more confident conclusion about the effectiveness of interventions in this area.

Other forms of blindness include corneal opacities, glaucoma, diabetic retinopathy, age related macular degeneration, and childhood blindness.

The charities investigated are ones which are partners of the WHO or International Trachoma Initiative, and which are working in the developing world on cataract, trachoma or onchocerciasis (and not working on a range of other causes that seem less effective). There are some more, though the ones below likely include most of the major charities.

 works in a very broad range of areas, including cataract surgeries, trachoma fighting, antibiotic provision, and eye screenings. Out of a total of A$41.5m on program expenses, the Fred Hollows Foundation likely spent between A$10 and A$20 million on the most effective interventions. The $/DALY figure of FHF is around 180-450 (taking cataract surgery at $90/DALY).

 received $77,876,062 of in-kind medical supplies and medicine – very close to the figure for the distribution of in-kind medicines. As a result, it seems likely that additional donations will go towards the other programs. A significant proportion of other expenditure seems to be spent very effectively – a combination of effective interventions. The focus is on nutrition, which it is outside the scope of the report to consider, but seems promising. As such, HKI should be investigated further, though predominantly from the perspective of nutrition.

 do not publicly provide data on the amount spent on areas within eye health. On their page on cataract, they put screening above provision of surgery, suggesting surgery is not their focus. In their financial reports, under surgery they specified the causes of blindness in brackets –“cataract, glaucoma, diabetic retinopathy, trichiasis in that order – suggesting that their focus is not exclusively on the most effective causes. We have emailed them to find out more but have not currently received a response.

From the above, the charity that seems most effective is Helen Keller International because of the high proportion spent on effective programs. However, to be sure of this, one will need to research their nutrition interventions in greater depth. SightSavers’ lack of transparency on the distribution of expenditure on eye care is surprising given the amount of other financial information they provide, but it seems likely that a significant proportion will not be spent on effective interventions. The Fred Hollows Foundation similarly seems to spend a significant proportion on less effective interventions.

While blindness is a promising area, donors should look elsewhere to have confidence in finding effective donation targets. It will be worth re-evaluating in a few years whether more can be done by charities to increase cataract surgery provision, and whether trachoma and onchocerciasis continue moving towards eradication.

Blindness: an opportunity for effective giving?

Max Dalton

How valuable is medical research? Finding the solution to a problem in medical research is not only difficult, but it’s difficult to know just how difficult. Given that, how could we know the return we can expect on investing in medical research? Owen Cotton-Barratt is trying to find a framework for tackling precisely these kinds of questions. This post gives a sketch of his current model, and what it might be able to teach us about the value of medical research.

Owen Cotton-Barratt is Giving What We Can’s director of research, and also works on the Global Priorities Project (GPP) [1] within the Centre for Effective Altruism. The GPP works to try to find out how we should compare the different causes that we could be working on. This is closely tied to Giving What We Can’s aim of finding out how individuals can help people the most with their donations.

Owen’s current project is developing a framework to treat problems of unknown difficulty. It’s a work in progress, but he wanted to see whether the kinds of results the model produced would be useful by working through a specific example – the value of medical research. In this post I present a brief sketch of both his model and his results. Note that this work is very preliminary, and my statement of it is rough!

How might you go about finding out how much benefit you can get for an investment in medical research?

You need to build a simplified model that can start to give us a handle on what’s going on, but that gets the major effects approximately correct. This model aims to find a best guess for the average benefit (measured in Quality Adjusted Life Years (QALYs)) produced by an extra unit of resources (measured in dollars) invested in medical research, as well as some idea of how robust this estimate is. It starts by finding the general shape that returns to medical research would have, and then uses rough numbers about the world’s actual research spending and life expectancy increases to find out how many QALYs we might expect to generate per million dollars we put into medical research.

How do the outputs of medical research vary as resources go in?

In research in preparation, Owen argues that we should think the beneficial knowledge from a research area will scale approximately logarithmically, in expectation, with the resources invested. If the research area has many small discoveries rather than a few large discoveries, its development should also exhibit roughly logarithmic behaviour. In the case of medical research, this appears to be a reasonable assumption.

This means that a doubling of resources is equally good regardless of starting point. So money would have diminishing marginal value when put into research, as we might expect. Of course, this model does not hold for arbitrarily large values, but it is a fair approximation over the range we’re interested in.

Blog

Can schistosomiasis be eliminated? Lessons from Coca-Cola and other stories.

The World's Hidden and Deadly Hunger

Against Malaria Foundation: August - September Update

Evidence Action - August Update

Where is the money in development spending?

Blindness: an opportunity for effective giving?

How valuable is medical research?

An Update on Evidence Action

What you need to know about school-based deworming from SCI

What is the UK's most generous town?