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Clara Marquardt

‘Real World Evaluations’ – randomising on a national scale

Giving What We Can promotes effective altruism - giving informed by rigorous evidence of programmes' and projects' effectiveness. An increasing demand for evidence necessitates a corresponding growth in the supply of such evidence by NGOs & social enterprises. Clara Marquardt from the Cambridge GWWC chapter interned over the summer with 

, an organization aiming to conduct "the most robust evaluation that has ever been conducted of a mass media intervention in a developing country". Clara took the opportunity to discuss the movement towards impact measurement and the challenges associated with real world randomized controlled trials with Will Snell, DMI's Director of Public Engagement & Development.

Clara: Could you give us a brief overview of DMI's objectives and approach?

Will: I would describe DMI as an organisation that uses radio and television to improve health outcomes, especially maternal and child health outcomes, in developing countries by changing behaviours. We are bringing together two different disciplines. One is the creative and logistical expertise in managing large-scale multi-issue media campaigns focused on for example the prevention and treatment of diarrhoea or safe child birth; the second is the scientific rigour of measuring the health impact of those campaigns.

We have developed a statistical model with the 

London School of Hygiene and Tropical Medicine (LSHTM)

 that allows us to predict and then measure not just behaviour change outcomes of a campaign but also health impacts in terms of numbers of lives saved. Historically there has never been any such attempt to measure or model the impact of media campaigns on mortality. This is because the impact on all-cause mortality is very hard to identify statistically given the many possible causes of deaths and the limited impact of any campaign.

The model predicts that DMI's campaigns will reduce under-five mortality by 16-23% within each African country at a cost that is as low as that of any other available intervention…between 2 and 10 USD per DALY.

Clara: You have already mentioned a defining characteristic of DMI - a strong focus on 'science' and impact measurement. How did this come about?

Will: This is a story about Roy Heads, DMI's founder and chief executive who had previously set up and run the BBC World Service Trust's health division and in doing so had worked on a large number of extremely successful mass media health campaigns.He set up DMI with the objective of injecting a more scientific approach because he felt that the impact of these campaigns while significant was not being measured sufficiently robustly.

Amongst other things this was leading to a lack of prioritization of such campaigns by funders and governments…the aim was to prove their impact and thereby persuade donors to make this a public health priority alongside complementary supply side initiatives. The scientific evidence base could also be used to maximize a campaign's mortality impact by informing the choice of health issues to campaign on.

Clara: Is DMI then starting to see this strategy pay off? Are donors and funders responsive to the provision of rigorous evidence? Which type of funder is proving the most receptive?

Will: DMI is starting to see the benefits and an increasing interest among funders. At the moment we have a track record, an evidence base based on behaviour change outcomes. The first time that we are directly measuring mortality outcomes is in the current Randomised Controlled Trial. While that is on going (endline results will be published in 2015) we don't have hard evidence on health outcomes other than a couple of campaigns where have been able to measure trachoma prevalence - in Ethiopia for instance. A lot of funders are responding to what we are doing. By definition the most science driven funders are waiting for the results of the Randomised Controlled Trial - this is gold standard evidence for them.

I would say that the major push for impact measurement is coming from certain bilateral donors who are extremely evidence and research focused, and also from some more public health focused organisations. Both groups of donors are driven partly by value for money considerations… I agree that the development of new financing mechanisms such as Development Impact Bonds (DIB) and the movement towards impact measurement are mutually reinforcing. The development of a DIB market is dependent on a certain amount of accurate data and evidence being available but once DIBs become more widespread this will motivate NGOs and other organisations to become more robust in terms of impact measurement in order to secure continued funding.

Clara: You have already mentioned DMI's on-going Randomized Controlled Trial (RCT) - an evaluation quite unique in its scope and scale. How would you describe the project?

Will: We were in discussions with the Welcome Trust when developing the DMI-LHSTM model to predict how many lives we save and they wanted us to provide some real world evidence that this could work. They funded us to set up a RCT to provide gold standard evidence that observed mortality reductions are attributable to our campaigns rather than other factors.

This is an evaluation design that has rarely if ever been used in the field of media - it is very difficult to randomize media interventions. We looked at nearly every country in Africa and Burkina Faso was the only country where this design could work because radio is very fragmented and localized. While there is a national network very few people listen to it, partly because it is in French, partly because it is under resourced. Everyone listens to local FM community radio stations and TV is more or less non-existent in rural areas. Given the presence of 'media dark areas' we were able to select 14 zones across the country each measuring roughly 50 km radius around a small town and randomly selected 7 to be intervention zones and 7 to be control zones.

Map of Burkina Faso showing intervention areas in blue and control areas in red

In the intervention zones we are broadcasting a 2.5 years child health campaign - a mixture of radio spots (one minute adverts broadcast 10 times a day) and dramas (interactive 5-10 minute health dramas broadcast every evening) (see 

Clara: From a technical perspective, you have already explained how you managed to implement treatment randomisation on a national scale. Are there any other areas where the Burkina RCT did diverge from the idealized 'textbook' RCT methodology? In other words, what are the challenges of actually realizing this rigorous evaluation design?

Will: Sure, the most obvious way in which we have diverged from an idealized design is in the number of clusters. Having 7 intervention and control clusters reduces our statistical power to attribute impact.There are obvious practical reasons why we couldn't go beyond that: There are a limited number of radio stations in Burkina Faso with a sufficient listenership. Also, this is a 12 million USD trial - would we have doubled in size we would have more or less doubled in costs. That notwithstanding we have a 80% statistical power (a one in five chance that we will have a significant impact on mortality but won't be able to prove it statistically).

The other area in which we have faced scientific challenges has been around controlling for other health interventions. There are a number of nationwide interventions including vaccination campaigns that should theoretically affect control and intervention clusters equally. But there have been some health campaigns where there has been a possibility of them broadcasting or operating in some areas but not in others. We have been working closely with the Ministry of Health to try and avoid that happening during the broadcasting period of our trial. That has been possible in most cases so we think that contamination from other projects is minimal… but will never be completely eliminated.

Clara: You have referred to two potential constraints on the implementation of RCTs: Their high cost and their long duration which makes it harder to minimize potential contamination. Based on such considerations what is your take on the World Bank's assessment that "experimental designs…can only be applied in a very small proportion of impact evaluations in the real world…RCTs can probably only be applied in less than 5% of impact evaluations" [1]? Seeing as DMI has already shown that randomization, one of the key challenges, is realisable on a national scale do you see the Burkina RCT as a confirmation that RCTs can be become more widespread?

Will: We knew this from the start - we would not be expecting to run RCTs on a regular basis. We will look at opportunities for future RCTs because it is clearly a level of rigor that other designs will not achieve … but it remains difficult to run RCTs around media in most contexts.

For campaigns in other countries we will probably be looking at quasi-experimental evaluation designs such as non-randomized controls and time series analysis which permits a much greater degree of flexibility in terms of campaign design.

Clara: Would you nevertheless agree that there are ways of reducing the cost and burden of conducting RCTs? Would you in this sense see your strategic collaboration with LSHTM as a model for future RCTs? How about the call for 'piggybacking' on existing data gathering efforts in place of conducting independent and costly baseline and endline surveys?

Will: I do think the bringing together of DMIs and LSHTM's technical expertise is a viable model. Our future research will no doubt be based on similar partnerships. Any partnership brings its own complexities but I think that the benefits to this kind of partnership outweigh these. From the NGO, implementer perspective it makes sense to partner with an academic body with the independence to provide credible results and the necessary technical Measurement and Evaluation expertise. From the academics' perspective, the NGO will hopefully have the expertise in managing and implementing the intervention in question.

I think that there are increasing possibilities of using secondary data sources, especially when a project is in some way interfaced with the health system and outcomes are measured in terms of increased health system usage (which is measured by Ministries of Health) - appointments for children with malaria or sales of Oral Rehydration Solution (ORS) sachets for instance. It has been difficult for us in Burkina Faso partly because there are few reliable data sets and partly because many of the behaviours we are promoting are household behaviours such as breastfeeding that the government is not recording. RCTs demand a level of rigour at every stage of the process that limits the number of appropriate existing data sets.

Clara: Are there any challenges associated with DMI's movement between RCT and quasi-experimental evidence? In other words, is there a risk that once DMI is committed to the RCT standard of evidence funders will discount other evidence?

Will: There certainly is an issue around potential funders waiting for the RCT results despite the fact that our evidence base is already stronger than that associated with most other (mass) media campaigns. In terms of moving from RCT to non-RCT evidence in the future we can break it down into two parts: One is the attribution of impact and the second is the conversion of behaviour change outcomes into lives saved impacts.

The RCT's aim is to as far as possible show that firstly, there is a direct link between the radio campaign and lives saved and secondly, that our model accurately predicts lives saved based on the intermediary behavioural change variable. Assuming that this is the case we will then be able, with reasonable rigor, to say that in future campaigns we don't need to measure mortality which is much more costly for a numbers of reasons including the larger sample sizes required. Instead it will be sufficient to measure behaviour changes and use the 

 (an independent tool funded by the Bill & Melinda Gates foundation that predicts how many lives could be saved in different countries if the coverage of key interventions such as breastfeeding and insecticide treated bed nets was increased from their current level) to translate behaviour changes into lives saved.

The remaining challenge then is to attribute our behaviour change impact to the campaigns. This will require us to use the most sophisticated quasi-experimental designs that strike the right balance between robustness and technical viability - we are working on developing such kinds of evaluations. One example would be dose response analysis: When we are conducting Knowledge, Attitude and Practice surveys (the standard term for surveys that assess people's belief and behaviour changes) we also ask people whether and how much they have been exposed to the campaign. We can then break down the behavioural data by campaign exposure. If people with low campaign exposure changed their behaviour less than people with high exposure that provides us with the additional evidence that the campaign itself was having the impact.

Clara: There has always been a concern over the external validity and generalizability of RCT results. Specifically, a concern over the lack of understanding of the process of change behind observed results and the contextual, mediating factors that enabled the results to come about. In DMI's case these could include supply side health interventions or specific features of the radio stations' broadcasting formats. What is your understanding of these factors in relation to the Burkina RCT? To what extent can you move beyond the statement that "a very specific mass media campaign using context specific stories reduced mortality in the specific socio-political environment of Burkina Faso, Africa by x%"?

Will: The longer and more complex your theory of change the harder it is to generalize the results of an RCT which reveals significant impacts of an intervention. Our theory of change is relatively straightforward with effectively only one intermediary variable and outcome - behaviour.

In order to better understand the link between media messages and behavioural changes we are conducting qualitative research to compliment the quantitative research. We do this partly to inform our message production in terms of understanding barriers to behaviour change and to pre-test spots for accessibility and impact but also to understand responses of our audiences using feedback research with individuals and focus groups. That gives us some idea - anecdotal - to what extent people are changing their behaviours and whether if they are changing them that results from direct exposure to the campaign or from having heard the messages being discussed in social forums, from neighbours and friends.

Clara: Everyone within DMI is very aware of the limitations of the trial's results but how do you communicate this to the public? How will DMI communicate the results so as to maximize their (policy) impact while acknowledging their limitations and contextual background?

Will: If the results are positive of which we are confident - but then you can never guarantee this - the challenge will be to be optimistic but realistic about their generalizability and contexts. We are optimistic about this. While Burkina Faso is an easy country to work in in many ways it is also a very challenging environment in terms of healthcare provision and media penetration. Programs that work in context of Burkina Faso's very limited health care service are likely to work in other countries.

The opposite danger is that the results foster a sense that any media campaign can have a similar impact. We will be doing our utmost to emphasize that much of the success of the trial was due to the way in which it was implemented. Promoting not just the use of media to change health behaviours but a specific approach as to how to do that. We have a developed an approach which we call Saturation+ that comprises three aspects: Saturation, reaching the largest possible proportion of our target audience; science, using the models we discussed to maximize health impacts and to measure health impacts robustly; and stories, investing in both the qualitative research to identify behavioural barriers and a creative process linking local scriptwriters with international experts and expertise.

Clara: A recent publication on Development Impact Bond has called for them to be "open by design", to use a "share standard of reporting and conducting trials", and to "create organizations and funds to…systematize the evidence"[2]. To what extent are these observations relevant to RCTs? In what ways will DMI contribute to the building of a body of evidence on how to conduct real world RCTs? Is there a potential conflict between DMI's social motivation and purpose which is served by growth of evidence-based approaches and the need to protect DMI's expertise and distinctive features?

Will: The DMI-LHSTM model has an intellectual property aspect to it, but all the model does is to model health impacts and thereby maximize campaign impact via message selection. The most effective way to maximize health impacts lies in the approach to running campaigns - our communication strategy will therefore focus heavily on our Saturation+ approach that we will be sharing widely.

Our focus is on sharing the results and the information that helps people run effective media health campaigns rather than on sharing insights on how to run effective RCTs. This goes back to our view that there most likely won't be too be many future RCTs in this area. Where forums such as the International Initiative for Impact Evaluation (3iE) or the Poverty Action Lab (J-Pal) are however interested in aspects of our implementation process we will share this information.

[1] "Conducting Quality Impact Evaluations under Budget, Time and Data Constraints", The World Bank Independent Evaluation Group, 2006

[2] "Development Impact Bond Working Group Report", Centre for Global Development and Social Finance, 2013

This is a slightly compressed and edited version of the original interview. Thanks to Will Snell for participating in this interview!

Lottie Malton

Interning at Giving What We Can: The People's Perspective

Lottie's second post on the Summer Internship focuses on the more anecdotal insights to the fortnight and gives personal responses from the people involved.

There are three main insights I will be taking away from my time with Giving What We Can: One conclusion is that being nice and doing good seems to be contagious. About 3 days in to the placement and I noticed myself letting in more cars on the motorway, starting up conversations with the bus driver and stepping aside for strangers on the street far more than normal. In case that gives the impression I was previously a horrible person and have now just been dragged up to normal levels of civility, I consulted my friends as to whether they thought this was the case. Confirmation that I was not previously rude suggests to me that spending 9 hours a day in an office with 20 other morally motivated interns working on alleviating world poverty may have rubbed off on my everyday mood and demeanour, a rather happy consequence.

My second personal insight is that I can and should be more productive with my time: when I could draft a speaker invitation or grant application in a spare 30 minutes to help further the work of Giving What We Can, the similar amount of time I spend each day scrolling through Facebook or YouTube seems rather worthless in comparison. In an office full of highly motivated individuals I picked up many time-management strategies as ideas to streamline my day as well as a greater sense of urgency. Fingers crossed that the dedication and work ethic will extend to my university studies this year.

The third thing that will stick most in my memory is when someone pointed out that by getting just one new member to sign the pledge you will have helped move a huge amount of money to one of the world's most effective causes. The contribution just one pledge makes towards alleviating poverty is just so great that I know this thought will motivate my work for Giving What We Can over the next year.

In order to get a more diverse perspective of the GWWC intern experience the other interns gave me their views:

"The internship has really got me thinking about the message of Giving What We Can, and the power and responsibility we have to improve the lives of those living in poverty. I hope to stay involved with Giving What We Can after the internship." 

"I have had a great time on the internship because I felt like I was able to be really independent whilst also getting as much help as I needed. It felt like we were really valued and as well as the work itself the talks and workshops meant that I feel like I've learnt so much." 

"Being surrounded by similarly passionate people made coming into the office everyday a really rewarding experience and something I looked forward to, rather than a chore. I'd recommend this internship to anyone and everyone who has some interest in charity." 

"Doing the internship has been useful and rewarding. It's a much better use of the fortnight than anything else I could have been doing in that time, and I've enjoyed the sense of community which makes this workplace distinct." 

"Giving What We Can has Given What It Can to persuade me to Give What I Can (to fight global poverty) for the rest of my life." 

The September Internship-Part I

Giving What We Can's September Internship finished last Friday and was a great success! In the first of two posts, Lottie Malton describes her time here.

So what really happens at Giving What We Can HQ? That was the question on my mind as I prepared for my 2-week September internship at the Oxford offices of Giving What We Can. As I coordinate events and publicity for the Cambridge Chapter, I had experience within a University setting, but had no idea what else was involved. So with my laptop ready for action I arrived at the offices on Monday morning with an open mind to what would be happening in the following fortnight.

A morning of ice-breaker games gave the 20 interns a chance to get to know each other before we started work on our projects. We were all given detailed briefs and had a meeting with a member from the central Giving What We Can team to explain to us what we would be doing in our time there. These projects ranged widely, with some working on new promotional videos and info-graphics, some writing blog posts and grant proposals and some researching the value of interventions such as Water Sanitation and Hygiene.

My tasks drew upon my degree discipline, Psychology, as I was to research the psychology of persuasiveness and how these principles could be applied to both the website redesign and conversations about Giving What We Can. Many others were also engaged in projects that made the most of their strengths and throughout the internship there were always opportunities to tailor our roles to our interests. Talking to the other interns near the end of the fortnight it was clear that many shared my perspective of having been pleasantly surprised to find themselves entrusted with such responsibility in their roles. It was great to know we were contributing to the future of Giving What We Can by providing really valuable information, resources and research.

The projects however were only the half of it. There was a rich programme of workshops and information sessions for all the interns which gave us many opportunities to learn more about Giving What We Can as well as improving our own skill sets. For example, a public speaking workshop made us face up to our fears and gave us really valuable tips and pointers relevant in any professional field. An ethical careers session by Ben Todd of 80,000 hours (Giving What We Can's sister organisation) provided us with some really constructive suggestions, particularly relevant for those of us going into a final university year. After a one-to-one session I walked away with a list of contacts to talk to, career paths to explore and new ways to view the impact my career could have in the world.

The Chapter Workshop day was another highlight for me. In one day we covered important issues in running a university chapter, including consistent branding, event management, the psychology of speaking persuasively about Giving What We Can and how to run a Big Match campaign, a great new initiative started by the Warwick Chapter. Not only did we all learn a lot about Giving What We Can throughout the day, the opportunity to talk with members from other chapters really helped with the generation of new ideas. Exciting things will definitely be happening in the coming months!

At the end of two weeks I feel like I have learnt an incredible amount and not just about Giving What We Can. With no prior experience of an office environment I really valued the insight into this kind of working life. Having daily check-ins with senior staff, observing the structure of an office team, and seeing how to develop a great working ethos were all new to me but will definitely stand me in good stead for any future career. Others mentioned the benefits of being able to see a relatively new organisation in a period of growth and how this was being managed. Discussing our post-internship plans a number of us are keen to get more involved with university chapters, writing blog posts and fundraising for our recommended charities. Many of the ideas thought up over the two weeks will be developed further and implemented over the next few months, so hopefully the impact of our time at Giving What We Can will extend beyond the two weeks work we have done.

Summing up the internship is difficult for me, as I don't feel like it's the end of something. There isn't a sense of finality as I prepare to return to University because so much of what I have learnt will be coming with me. My only words of advice would be that if you are at all interested in Giving What We Can and their vision of alleviating world poverty by 2030, then apply for next September's programme. In the meantime just watch this space, as between now and then we have a whole lot of exciting plans.

Giving What We Can

A CONVERSATION WITH HOLDEN KARNOFSKY, CO-FOUNDER OF GIVEWELL-PART III

Part III: Funding Randomised Control Trials

Recently, Giving What We Can staff sat down with Holden Karnofsky, the co-founder of GiveWell. The goal was to try and critically explore GiveWell's methodology, research approach, and recommendations. The 

Rob: While you think there's a lot of value in learning about giving opportunities, you haven't recommended any charities that are explicitly trying to do this, like the randomised controlled trials of JPAL or IPA. Probably the reason you haven't done that is it's harder to get evidence of their impact - connect the dots between the reports they write and spending by governments or aid agencies. Is this a mistake?

Owen: If you think there is some kind of market efficiency in charity giving, isn't getting more information out there about the best charitable intervention going to have be massively good?

Holden: I think that's a reasonable argument. Randomised controlled trials are a good example. We've had tons of ideas about RCTs, but we dropped most of them, because the softer the data is, the more it helps to be an expert in the area before you have faith in your ideas. We've just never come to an idea about RCTs that's worth our time trying to write.

Owen: We're not suggesting that you actually do RCTs, but why hasn't GiveWell looked into a charity that does RCTs in global health?

Holden: The reason we recommend what they do is that we think they are the best giving opportunities we can find and we have a good view of how they will go. We've tried to understand what the general operations support of JPAL and IPA do and 

, but we couldn't get any good idea of what they would do with more funding from that.

Perhaps you would say that more funding would produce more RCTs, but keep in mind the timeline - good RCTs take years from start to finish. The one's we've learned from are the ones in global health where there are a lot of them and places like Cochrane Reviews have pulled them together, and we haven't learned as much from RCTs looking more into social science, and we don't think they're worth recommending.

By directing more money toward producing RCTs, it seems we'd just be increasing the supply of RCTs, which is not the same as GiveWell forming hypotheses and seeing how the charity will proceed, given more money.

Rob: You've said that when you've found it difficult to determine what JPAL or IPA would fund with extra money, and they probably don't even know what their marginal product is because of the timescales involved. But is it a sensible requirement to know what they will do? If these organisations have been sensible in the past, might they not make good choices in future?

Holden: I think I've misunderstood the question. There are two potential goals - form hypotheses and follow impact of donations and just increasing RCT supply. I agree that donating to IPA or JPAL will increase the supply of RCTs, but I disagree that they'll help with our hypotheses. Only a minority of RCTs actually change the way we think about aid.

Rob: When you're looking at JPAL or IPA, what are you comparing them to? Isn't it so hard to find the impact of any of that, and therefore we'll never know what it's most appropriate to compare JPAL and IPA to, especially when trying to figure out how much we should adjust our estimates downward based on considerations not included in the explicit cost-effectiveness estimations?

Holden: This is another are where there are thousands of possible comparisons and we should be thinking about that rather than looking for one particular line of comparison. There's a general comparison we can make to the track record of quantitative social science and the track record of research in general influencing policy. Also, in general, we should just expect that opportunities to do good will be closer to the average than they initially look, especially when we don't know much about them.

Carolina Flores

Is an end to malaria in sight?

A new vaccine against malaria using parasites from irradiated mosquitoes has just passed the first phase of clinical tests with 100% success, surpassing large difficulties in production and improving greatly on any previous attempts. If further trials confirm this result and obstacles to distribution and application are removed, an end to malaria may be in sight.

At the start of August, Science magazine reported on the impressive results of PfSPZ in its first safety trial. This vaccine was developed by Stephen Hoffman's team in Sanaria, a company based in Rockville, Maryland, using parasites from irradiated mosquitoes. The six subjects given five doses intravenously were 100% protected from later bites by infected mosquitoes, whereas five of six unvaccinated controls developed malaria, as did three of nine people given only four doses of the vaccine [1]. Previous vaccines had never come close to this level of efficacy.

The next phase is the implementation of larger trials in regions where malaria is rampant, which will test for protection against different strains and on different age groups. One is already set to start in the Ifacara Institue in Tanzania. Hoffman hopes to have a vaccine licensed within four years.

If that goal is achieved, the benefits to developing countries will be enormous. Every year, malaria kills between one and three million people, and infects as many as half a billion people [2]. The economy slows down and a huge burden is placed on the health system.

An effective, widely distributed vaccine would highly reduce the incidence of malaria and therefore make a crucial contribution to these countries' development, as acknowledged by the World Health Organization (WHO), which set as a target the creation of a vaccine with 80% efficacy by 2025 [3]. Is the PfSPZ going to be the vaccine to achieve this?

A different approach to vaccination against malaria

Results from the 1970's which showed that immunization with over 1000 bites by irradiated sporozoites confers about 90% protection against infection, lasting for 10 months [4]. Hoffman decided to try to create a vaccine of equivalent effect.

This led him to using the whole Plasmodium falsiparum (Pf) - the parasite which, out of the four strands that cause malaria, accounts for almost all the fatal cases - in the sporozoite (SPZ) stage of its life cycle. This approach was radically different from the mainstream line of employing just a handful of proteins from the parasite. Initially, many researchers were sceptical of the possibility of mass-producing sporozoites (between ten and a hundred thousand per vaccine) within the required health and safety standards.

Against the odds, Hoffman's team managed to construct a successful production process. The researchers raised mosquitoes in industrial quantities, fed them with infected blood, and irradiated them to weaken the parasites, so that they can infect but cannot cause the disease. After that, the parasites were harvested from the mosquitoes' salivary glands, purified and cryopreserved to obtain the vaccine.

Despite the initial success, optimism must for now remain cautious. First of all, unlike most widely used vaccines, which are given orally or by injection just under the skin, the PfSPZ is intravenous. This makes it harder to apply, particularly to children. As 70% of malaria deaths are of children under five, this is a serious issue.

Under-the-skin vaccine trials have not been successful: in 2011, only two out of eighty participants were immunised [5]. Hoffman claims that the small volume of the vaccine (0.5 millilitres) and the tiny syringe required will make it widely applicable, especially taking into account that the company is looking into improving the intravenous delivery system; but other researchers believe that it won't be possible to use on children.

Secondly, the vaccine needs to be kept frozen in vapour nitrogen phase, which is an obstacle to distribution. However, it should be able to piggyback on veterinary infrastructure, and to be transported with veterinary medicine and semen for insemination of livestock.

Though it is still hard to predict whether this vaccine will be successful, it is undeniable that it represents a big step in malaria research, and that it gives new reasons for optimism about reducing the incidence of the disease.

http://dx.doi.org/10.1126/science.1241800

http://www.againstmalaria.com/Faq_malaria.aspx

http://www.who.int/vaccine_research/diseases/soa_parasitic/en/index4.html

[4] Hoffman, S. L. et al. J. Infect. Dis. 185, 1155-1164 (2002).

[5] Epstein, J. E. et al. Science 334, 475-480 (2011).

http://www.nature.com/news/zapped-malaria-parasite-raises-vaccine-hopes-1.13536

Peter Hurford

Smart Development Goals: A promising opportunity to influence aid spending via post-MDGs? 

Giving What We Can recently concluded its investigation of the Copenhagen Consensus Centre, discussed previously in our post “

Copenhagen Consensus: Making a Bet on Catching a Big Fish

 (CCC), known for organising research forums on global prioritisation, aims to influence the next round of 

 via research and public advocacy, beginning now and continuing until the post-MDG process completes in 2015. The CCC is of particular interest to us as it represents the primary example of an organisation engaged in global prioritisation research. We are by nature highly sympathetic to this research, which we have used several times. In addition, we have done 

 suggesting high levels of cost effectiveness for further funding of research of this kind.

The Millennium Development Goals (MDGs) are set by the United Nations every fifteen years and provide guidance for spending of international aid and development assistance. These goals have included cutting extreme poverty and global hunger by half. They also specify metrics by which to assess whether goals are met.

CCC’s plan is to influence the next round of MDGs by (a) involving UN ambassadors in full-day sessions exploring the results of their cost-benefit analyses, working with them to set individual priorities, (b) doing the same with the NGO community and journalists, and (c) reaching out to the public via a website and articles in major publications. CCC’s research is already fully funded, but greater funding is needed for publicity and outreach.

CCC’s case for impact is that (1) changes in the MDGs can cause large changes in the distribution of international aid, (2) the CCC can recommend goals that predictably deliver better value for money, and (3) CCC will have a good chance of influencing the MDGs. If these claims are true, then CCC can potentially move billions of dollars to higher-impact causes.

Detailed analysis suggests that the CCC is able to make a reasonable case in support of its core claims. Analysis of aid spending data, alongside testimony from NGOs and governments, shows that the MDGs are highly likely to influence a significant share of the total aid budget. It is also plausible that there is sufficient variance in the cost-effectiveness of the MDGs that rearranging them would be impactful. Finally, by focusing on cost-effectiveness and evidence-based prioritisation to a greater extent than other groups, CCC has a credible claim to be able to select better goals than other parties involved in the process.

While we are very impressed by the work of the CCC, we have a number of lingering concerns that keeps us from recommending this project alongside our top-ranked charities, such as the Against Malaria Foundation. In particular, we’re concerned that the CCC is spending too much time on controversial arguments challenging the cost-effectiveness of climate change mitigation, that the MDGs might already reach a decent outcome without their work, and that CCC experts make overly confident claims about their modelling and the future.

. Given the pressing demands of its current research work, our investigation has been constrained by the limited time available to the CCC in speaking to us, addressing our concerns, and preparing documents. Nonetheless, we believe the information contained in this report will be useful to both members and the general public.

While we commend the work of the CCC, we do not feel that we can yet recommend this project alongside our top recommended charities, such as Against Malaria Foundation or Project Healthy Children. However, we are taking a ‘wait and see’ attitude. This project is still in the process of getting off the ground. We do not yet know what CCC’s recommendations will be, and have limited information about what messages they will focus on in their sessions. We cannot say with very much confidence to what extent climate change is likely to figure as a focus for advocacy, nor to what extent the CCC’s recommendations will diverge significantly from those otherwise favoured by the MDGs process. We’ll continue to monitor CCC’s efforts to influence the MDGs, and are prepared to reconsider if our doubts turn out to be unfounded.

A CONVERSATION WITH HOLDEN KARNOFSKY, CO-FOUNDER OF GIVEWELL-PART II

Recently, Giving What We Can staff sat down with Holden Karnofsky, the co-founder of GiveWell. The goal was to try and critically explore GiveWell's methodology, research approach, and recommendations. The 

Giving What We Can's aim was to act as lawyers, not judges, to help GiveWell smooth over any potential flaws and become more accurate. In playing the 'devil's advocate', Giving What We Can might come across as more negative and skeptical than is their actual view of GiveWell.

Ultimately, these conversations are valuable because GiveWell relies on people to challenge them but, often enough, there are not enough feedback loops in the world of philanthropy. Giving What We Can's recommendations will also be improved, since we rely heavily on GiveWell's research. Likewise, it should benefit the thousands of people who donate based on GiveWell's recommendations and the hundreds of people who have taken Giving What We Can's 

You can find the first part of the interview 