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

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

Donate

Pledge

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

Leave feedback or make a complaint

About

Our best charities

Take a giving pledge

Get involved

Make a bequest

Videos, books, podcasts

FAQs

Learn more

Press kit

Media coverage

Case studies: People who pledge to give

Media

Footer Navigation

topNavigation

Our research team’s 2026 recommendations

How we choose which charities to recommend

Other places to donate

Create a fundraiser

Best charities

The 10% Pledge

The Trial Pledge

Pledging vs. donating

View all pledgers

Share your pledge to inspire others

Motivations

Stories

Giving pledges

About our research

Browse our guides and resources

Connect with our community

Read our blog

Help others discover effective giving

Birth Lottery

How Rich Am I

Research and resources

Who we are & what we do

Our structure

Mistakes

Top Navigation

Krisztina Csortea

What do you get when 30,000 people rally in London's Hyde Park?

If you're in London this weekend, don't miss the Big IF, the Enough Food If campaign's rally in Hyde Park on 8 June.

On the same day as the PM holds the International Hunger Summit, you can take part in the rally and demand action on hunger from the G8.

According to the organisers, the line-up will include effectiveness pin-up and 

 Bill Gates, the outspoken former head of the Church of England, Rowan Williams, and other celebrities from sport and TV.

) on the effectiveness of campaigning for increased aid - we're pretty uncertain of its value - but the Enough Food If campaign is also about governance issues: land, tax and transparency. It's an interesting example of hundreds of NGOs coming together on one campaign platform - last seen on this scale in the 

Whatever its effectiveness, the rally at least promises to be an inspiring way to spend a sunny Saturday. There's another rally in Belfast on 15 June. This is all timed to coincide with the UK Government's hosting of the 

 in Enniskillen, Northern Ireland on 17-18 June, which Prime Minister Cameron has said will focus on tax, transparency and trade.

If you do go check out the rally, let us know how it went down!

How Giving Games can spread the word about smarter charity choices

A member of GWWC: Cambridge, details his experience with two types of Giving Games and their use in spreading the word about making smarter charity choices. His experience suggests that the games are a great way to get people thinking about effectiveness, for three reasons: (i) it's not their money they're forking out, (ii) direct comparisons are made between just two charities, encouraging rigorous debate, and (iii) it's actually pretty fun.

Giving What We Can has only been around for a few years, and the idea of choosing a charity based on its cost-effectiveness is still one many people have never consciously considered. Part of having a big impact is not only donating to the most effective charities yourself, but getting others to make their giving decisions more rationally. If you can get lots of people to change the way they think about charity, your impact could be 

But how can we do this? One inventive way to get people to think more strategically about charity decisions is to make a game out of giving. In the Giving Games run by 

, a pot of money is provided by an anonymous donor, and participants are presented with a choice of two or three charities where the money can go. After hearing some information about each charity and discussing the options, they then cast their vote. The charity with the most votes wins the pot.

Giving Games are a great way to get people thinking, as they are completely frictionless. Since (i) it is not their own money they are having to fork out; and (ii) there are only a couple charities they are allowed to choose from, participants have nothing stopping them from thinking very clearly and doing a direct comparison between the charities. Taking part in the game is also pretty fun.

, they can also take physical form. I am involved in the GWWC: Cambridge chapter, and we have run two Giving Games in the last few months. Here's what happened.

Giving Game 1: Schistosomiasis Control Initiative vs. Wikimedia Foundation

We staged this game at a stall in the foyer outside a conference on Higher Education. Every hour or so there would be a 15-minute break between sessions of the conference, where attendees would mill around with not much to do but chat. Due to the nature of the conference we picked two charities whose work has a large impact on education: Wikimedia is the foundation that funds Wikipedia, whose aim is to provide free knowledge to anyone with an internet connection, while Schistosomiasis Control Initiative (one of GWWC's 

) cures children of parasitic worms, thereby increasing school attendance in the areas it operates.

The game worked as follows. We gave a penny to each person who approached the stall. This penny represented their vote: for each person who voted, the anonymous donor would donate £2, and if more than 50 people voted there would be a bonus of £250. Participants cast their vote by dropping their penny into one of two jars sitting in front of the charity of their choice. Whichever charity had the most pennies in its jar by the end would get the whole haul.

Since the choice involved one very well known charity, Wikimedia, this allowed us to attract people's attention and then tell them about the lesser known one, SCI. It also meant that they had some initial interest in the decision - for example, a few people mentioned how they had given to Wikimedia as a result of its banner advertisements in the past, and were now consciously considering the effectiveness of their contribution for the first time.

The idea was not to get people to arrive at the 'right answer'. Rather, it was to get them to think carefully about what the relevant considerations were that would lead to making a decision. It was very interesting to hear what people thought these were.

Here is a sample of some reasons that participants wrote down for voting the way they did:

'No one else does what Wikimedia do - while SCI are very important, organisations such as WHO already do good work in this field.'

'Because Giving What We Can and indeed all charities operate by informing people about global issues. Information makes people likelier to give to charity in the first place - wider impact!'

'Wikipedia is brilliant but I think the priority has to be offering children basic good health & education (without which they couldn't access the information on wiki!)'

'Wikimedia would potentially be able to attract funding more easily.'

'[SCI offers] a more direct improvement in quality of life.'

One conversation with a passing student started very normally: he asked what was happening at the stall, we explained the premise and a bit about each charity, then asked him how he thought he'd go about making the decision. He then proceeded to fret, and stayed at the stall for 10 minutes, talking through the different considerations in favour of each charity with us and often staring at the ceiling in thought. He finally cast his vote for SCI, and wrote a paragraph summarising his reasons, ending with: 'I'm really unsure about this decision'.

We were impressed by just how much people were willing and keen to engage with the activity, and think seriously about where to cast their vote. This was the point of the exercise; not just to get as many pennies as possible into a jar.

52 people cast votes. There were around 110 people at the conference, so over the course of the afternoon around half of all attendees took part!

£354 was donated to SCI! (£2 * 52 + £250)

Giving Game 2: Against Malaria Foundation vs GiveDirectly

 duke it out against each other. The format of the event was very different. This game took place in the evening, with more time for presentations of each charity, arguments on either side, and discussion.

Introduction to idea behind Giving Games and to the structure of the evening by our moderator, then President of GWWC: Cambridge.

charity assessment module from The High Impact Network

. One of the team presented participants with three neutral descriptions of social interventions that have been implemented in the past, and asked them to consider whether they thought the intervention had a positive effect, negative effect, or no effect. A show of hands was taken for each option, and then the actual effect of the intervention revealed. This encouraged participants to reflect on the reliability of their intuitions in assessing charities, and broke the ice before our main charities were presented.

Presentation of charities, AMF and GiveDirectly. Four of our committee members split into two teams and acted as 'charity representatives', presenting information about 'their' charity and making the case for why it should get the vote.

Wine, nibbles, and informal discussion of what had been heard so far.

Questions and discussion. Our four 'charity representatives' took questions from the audience, transitioning into a more fluid discussion between all participants.

Vote! Participants filled out ballot slips asking them for both their choice of charity and a reason.

Very brief GWWC presentation and presentation of results.

Informal discussion continued, and wine was finished off.

Again, we were pleasantly surprised with just how engaged participants were in the discussion of the different charities. An interesting debate arose on both the empirical level and theoretical level, about whether there were benefits in the 'ground-up', empowering approach of GiveDirectly that outweighed the proven track-record of AMF. In the end, though, GiveDirectly could not hold its own against the heavyweight charity champion of the world…

21 participants stayed for the whole evening

£10 was provided per vote, meaning £210 was donated to AMF!

The two Giving Games we have hosted in Cambridge have had a few major benefits. Based on the participants' decisions, £354 was donated to SCI and £210 to AMF.

This represents £564 going to the most effective charities out there. But it also represents a lot of people who may think about charitable decisions in a different way going forward, who have now thought in terms of cost-effectiveness. It is hard to quantify how much this will cash out in the future, in terms of money that will later be donated to the most effective charities. But when you factor in how many people took the events very seriously, and how many are now more interested in GWWC: Cambridge, I wouldn't be surprised if it's quite a bit more than £564.

Giving Games are a great way to introduce people to thinking about charity and effectiveness for the first time. And they can be really fun both to participate in, and to run. A lot of the feedback we received from people who took part in the second game said that they enjoyed how much more interactive the evening had been than a normal talk - so Giving Games can be a great way to build a local GWWC chapter too.

Anyone interested in holding a Giving Game should get in touch with Rob Gledhill, at 

Thanks to Clara Marquardt for writing parts of the 'Giving Game 2' section of this post.

Callum Calvert

Every. Last. Child.

Despite the exciting advances being made towards polio eradication, Callum Calvert argues that your donations could make a bigger difference elsewhere.

In general, disease eradication efforts seem like they could rank highly in cost-effectiveness. This is because eradication today will mean the large on-going expenditure of controlling the disease can be diverted to other programs tomorrow. Despite this, one eradication effort that Giving What We Can is unlikely to recommend donating to is the Global Polio Eradication Initiative. This time, however, it is good news! A global focus on polio, thanks in part to the Gates Foundation, has led to new funding from some of the world's largest donors. Thanks to this, the area is now well-funded, so the marginal impact of an individual donor's dollar is likely to be much lower than previously thought.

GWWC had previously estimated the cost-effectiveness of donating to GPEI by building on a model from Eradication versus control for poliomyelitis: an economic analysis (Thompson and Tebbens, 2007). This model assumes that there are two possible futures, with the likelihood of each depending on GPEI's level of funding. If the required level of funding is reached then eradication will be achieved soon (scenario 1). Alternatively, if the required level of funding is not reached then eradication will not be achieved, and instead cases will rise to 200,000 per year until 20 years from now when polio will finally be eradicated (scenario 2). The value of a donation is then calculated as the probability that the donation leads to funding being met multiplied by the difference in DALYs between the two scenarios.

This model produced an estimated cost-effectiveness of 0.15 DALYs per dollar. This number is very low - indeed it would beat our current recommended charities if it were to be taken seriously. However, there are a number of reasons to believe that this estimate is over-optimistic.

Most importantly, this assumed that our dollar was as useful in bringing about eradication as each previously pledged dollar. This assumption becomes less true as the total funding increases because the dollar we donate goes (or should go) to the least effective part of the eradication effort. New funding makes this part of the effort less effective. The 

 that philanthropists such as Carlos Slim and Michael Bloomberg are joining the long list of large donors backing this program makes it unlikely that this program will come close to GWWC's top recommendations.

This is great news! It is a strange quirk for donors looking for the most cost-effective intervention that an improvement in the state of funding for an area leads to disappointment that it won't be an opportunity to help more people than we could before. GPEI hopes that their $5.5 billion plan will eradicate polio by 2018. While $1.5 billion 

 it is unlikely that any failure will be due to lack of funding, given that the world's richest philanthropists and governments have given their backing to the plan.

Bill Gates, whose foundation has donated $1.8 billion to the program, has said that, if achieved, successful polio eradication will be "one of the great moral and practical achievements of our age". While GWWC won't contribute to this particular triumph, it will be exciting to watch as polio finally joins smallpox as the second human disease to be eradicated.

Sally Murray

Is it good to campaign for increased government aid to cost-effective interventions? Part 2

, I explained that if most government health aid is highly cost-effective, lobbying for governments to spend more on any specific cost-effective health aid project may be a bad investment. This, roughly, is because such lobbying would merely move aid from one highly cost-effective intervention to another- doing no overall good.

In this post, I will explain why we do indeed have some reason to believe that most government health aid is highly cost-effective, and so, advocacy of the kind described above may be a bad investment for an effective altruist.

As the world's biggest national donor to health aid, and the target of much advocacy, we began by investigating the cost-effectiveness of the US’s overseas development assistance (ODA) for health. (We later roughly check our results against other countries).

We attempted to estimate the cost-effectiveness of US health ODA by reading descriptions of its projects, and estimating their cost-effectiveness using secondary literature, mainly the DCP2. The individual projects that comprise the US's health aid are listed in the OECD's online QWIDS database, which provides a brief description of each aid project, as well as the amount of aid committed and distributed to it. There are thousands of projects in the database for each year, so for efficiency we took a randomised sub-sample of about 200 projects for the year 2010 (with greater representation of projects according to the amount of funds they received). Because this sample was relatively small, we later conducted an informal eye-scan of a far larger number of projects (~1000) to check if the results we'd obtained seemed representative- it seemed that they were.

Using the project descriptions, we matched each US health ODA project in our sample with its closest equivalent project in the DCP2- one of the most respected documents offering cost-effectiveness estimates for a wide range of public health interventions. In rare cases where we had better data regarding an intervention's cost-effectiveness, from, e.g. GiveWell or WHO-CHOICE, we used this improved estimate.

By thus matching project descriptions with cost-effectiveness estimates for most-similar programmes, we obtained a ball-park estimate of the cost-effectiveness of each intervention-type in our sample of US health aid. We then used this data to explore means, medians, spread, and so on.

So what did this process uncover? The basic story seemed to be that most US health aid is allocated to highly cost-effective final interventions: neonatal and early childhood care, polio eradication through vaccinations, HIV prevention (e.g. family planning, education campaigns), water hygiene and sanitation (WASH), and so on. The estimated mean cost-effectiveness of our sample was 34 DALYs averted per $1000- around three times as cost-effective as the highly cost-effective interventions that we have found charities lobbying for (mass drug administration (MDA) for neglected tropical diseases (NTDs), or the distribution of insecticide-treated bednets (ITNs) for malaria- which we tend to model as averting around 10 DALYs per $1000). This high cost-effectiveness was not due to a few very highly cost-effective interventions skewing our mean upwards: most of the projects (i.e. the sorts of projects listed above) came out as cost-effective at more than 10 DALYs averted per $1000 (i.e., better than deworming etc).

It is important to note that USAID's health programmes almost certainly do not have a mean cost-effective of 34 DALYs averted per $1000. Almost certainly, US health ODA is considerably less cost-effective than this (for reasons outlined in the footnotes). But importantly, many of the reasons (2-4 in the footnote) to downgrade this estimate could well constitute reasons to also downgrade expectations of the cost-effectiveness of mass drug administration for NTDs, the distribution of ITNs and so on, at least when these are delivered by a government aid agency. If both are less cost-effective, then again, moving money from an average health aid project to ITN distribution (etc) could still do no good.

We should also note, however, that an estimate that US health ODA is on average of similar cost-effectiveness to deworming is less bizarre than you might think. Giving What We Can recommends donating to deworming and ITN charities because of their high marginal cost-effectiveness: given the existing health programmes that are already being carried out, these are the remaining, underfunded, programmes with the greatest expected positive impact per dollar. It is quite possible that before GWWC came along, the 'lowest hanging fruit'- the most cost-effective interventions- were already being swept up and funded fairly well, and that funding these programmes continues to take up most of countries’ health aid budgets. The average cost-effectiveness of any organisations that plucked these low-hanging fruit should be better than their marginal cost-effectiveness, and could well be better than the cost-effectiveness of the interventions GWWC have identified as still underfunded (especially because GWWC focuses only on interventions that private donors can support).

We have also not checked how far our results for USAID generalise to other aid agencies with great thoroughness. Very briefly, we can say that the UK's Department for International Development has a very good reputation (generally better than USAID's), and within health also seems to focus on highly cost-effective interventions (evidenced by its annual reports, and QWIDS). A brief scan of other major aid donors’ health aid portfolios (Germany, Sweden and The Netherlands) using QWIDS suggests a similar composition to that of the US, except with considerably larger proportions spent on "health sector development"; we struggle to assess the cost-effectiveness of ‘health sector development’, or even to gleam exactly what it involves, so remain unsure as to how this should affect our cost-effectiveness estimate (Can you help?).

In summary, we don't have enough evidence to conclude that US health aid- or health aid in general- has a mean cost-effectiveness similar to that of highly cost-effective interventions like mass drug administration for NTDs or free ITN distribution. However, we have enough evidence to suggest this may well be the case.

And if this is the case, and if (discussed in my previous blog), successful advocacy for any particular cost-effective health aid intervention tends to move money away from a competing project of mean cost-effectiveness, this form of advocacy would do little good; it would certainly be a bad investment for an effective altruist. Due to these doubts and uncertainties, we cannot yet recommend donations to organisations whose main claim to impact is through the performance of advocacy that encourages governments to increase their spending on particular cost-effective aid interventions. If we are to recommend such organisations in future, we will need to receive much stronger evidence that they generate large, positive improvements in the overall cost-effectiveness of government aid.

*Reasons to think USAID’s health aid is not cost-effective at 34 DALYs per $1000.

1. Some of the funding for each project is spent on the administration and bureaucracy that support it. We expect that if it accounts for admin costs at all, the DCP2 treats admin costs as much lower than those actually borne by USAID, which has many levels of disbursement, hires expensive consultants, and so on.

2. Aid projects are not described to a good level of detail in the QWIDS database. This made it hard to identify the DCP2 interventions with which each project best corresponded, and thus to attach the 'correct' DCP2 cost-effectiveness estimate to it.

3. The cost-effectiveness estimates in the DCP2 are themselves tentative and sometimes inaccurate to an important degree (see, e.g. 

http://blog.givewell.org/2011/09/29/errors-in-dcp2-cost-effectiveness-estimate-for-deworming/

). We do not have good evidence to inform how we should adjust each estimate to take account of, for example, regression to the mean.

4. Our model assumes that if USAID stopped funding a health project, this project would stop completely. This is probably not true in many cases. It's likely that without USAID's help, developing country governments would fund and manage at least some of the programmes currently funded by USAID.

5. USAID’s health aid is $8 billion per annum. If each $1000 of this really were averting 34 DALYs, USAID’s health aid would be averting 264 million DALYs per year. If they were managing ‘just’ 10 DALYs per $1000 - a plausible, though very uncertain, estimate for the good done by deworming treatments - they would be averting 80 million DALYs a year. How plausible are those figures? To us, they both sound like a lot. The number of child deaths per year reduced by 5 million between 1990 and 2011, which suggests around 250 million more DALYs averted per year due to all reductions in child mortality over the past two decades. Could US health ODA be responsible for the equivalent of all of this gain (at 34 DALYs per $1000) or a third of it (at 10 DALYs per $1000)? Or consider that the burden of disease in Africa is 375 million DALYs (SOURCE: p. 60 of 

). Could the US be averting the equivalent of 70% of this burden (34 DALYs per $1000) or even 20-25% (10 DALYs per $1000)? To put the plausibility of such achievements into context, US health ODA is roughly 10% of total health spending in low and low to middle income countries. Furthermore, some improvements in health probably come from improvements in incomes, agriculture, urban planning, education and so on, rather than health spending directly. US health ODA could have a disproportionately great impact by being better-targeted (as evidenced by the QWIDS database research cited in this article), and less likely to be lost through corruption, than other sorts of health financing. It it also possible that US health aid would achieve less than average due to expensive layers of bureaucracy and salary payments, political priorities, and a lack of democratic accountability to recipients. Overall we judge it unlikely that US health ODA is achieving as much for global health as is implied by a cost-effectiveness of 34 DALYs per $1000, but are less sure of the plausibility of 10 DALYs per $1000. (What do you think?)

Peter Singer: The why and how of effective altruism

 is now available on TED.com! Please share, watch along with us and tell us what you think! You can find a written version of the talk 

If you've been inspired by Peter Singer's TED talk, you might want to read more about cost effective charities recommended by Giving What We Can 

Watch this space for posts on effective altruism and for responses to Professor Singer's talk in the next few days!

William MacAskill

Living on $1.25 a day - what does that mean? 

1.4 billion people live on less than $1.25 per day. What does that mean?

What it doesn't mean is that these people are living on what $1.25 could buy in, say, Kenya. If you thought that, then you might think that $1.25 isn't so bad, because money goes much further in developing countries.

Unfortunately, the fact that the money goes further in such countries has already been taken into account. What "$1.25 per day" means is: people living on this amount consume the goods equivalent of what $1.25 could buy in the US in 2005. That is to say, the figure is purchasing power parity (PPP) adjusted. That means we can work out how much, in actual money, people in Kenya live on below this line. In 2005, the purchasing power parity conversion factor was US$1 to 29.5 Kenyan Shillings. So $1.25 is about 37 Kenyan Shillings. At market exchange rate (today's rate, so again this is only a rough estimate), that's 44¢.

Because that's still talking about 2005 money, we want to adjust for inflation, so, assuming 3% inflation per year (again, keeping it rough), that's 56¢. So, in my view more accurately, we should say that the global poor, in Kenya at least - though other countries at an equivalent level of economic development have similar PPP conversion factors - live on 56¢ per day. Jeez.

However, the story doesn't end there, because "$1.25/day" doesn't refer to income. It is based on measurements of consumption. So when a person gather sticks from the forest for their own use - that counts as 'consumption'. Similarly, as far as I understand it, any free services provided by the government count in this as well.

So I think a more intuitive way to think about extreme poverty is: if you gave a Kenyan living below that poverty line 56¢, you'd have doubled what they can consume in a day.

A lot of people who know this about the $1.25 a day line subsequently refuse to believe it. I really struggle to believe it. Surely, if someone lived in the US on $1.25 a day, they would die! (I heard this argued in a conference on poverty by an academic who'd written several articles on poverty.)

If we're referring to income, I think that's simply not true. With an income of $1.25 a day you could have a much better quality of life than the extremely poor. You can dumpster dive and live off the excess of the affluent country; they have free access to roads and lighting, a good legal system and police protection, and medical assistance if they get sick. I know someone who lived on $1000 per year for a couple of years - several times more than the extreme poor, but he had a really pretty reasonable quality of life.

However, if you're thinking about consumption rather than income (as you should), there is a difference which does make the comparison to "$1.25 living in the US" misleading: in the US you just can't buy the sort of low-quality goods that you can in developing countries. Markets just don't exist for those goods. Even the most basic lentils and rice sold at Walmart in the US would be regarded as a luxury item for people living on $1.25 a day.

Eliz Kilich

Hilleman Laboratories: A potential answer to the inequity in vaccine need and vaccine supply?

Vaccines have delivered enormous health gains by eradicating some of the worst diseases confronted by humanity. As a result Giving What We Can has been looking into biomedical research projects as potentially high-leverage opportunities for donors. As part of our investigation we spoke with Hilleman Laboratories, a research group operating in new Delhi, India that tries to adapt vaccines to make them suitable for widespread use in the developing world. We concluded that thanks to seed capital from some large pharmaceutical companies they did not have any need for additional funding from our members. However, Dr Davinder Gill, Hilleman Laboratory's Chief Executive Officer kindly made time to talk to Eliz Kilich of Giving What We Can about their research and what 'funding gaps' remain in vaccine research.

What is necessary for a biomedical project to be worthwhile?

I think there are three essential components to a project being worthwhile. Firstly, there must be a public health need. Secondly, it is essential that the appropriate resources and networks are available and can be utilised effectively. The project needs to be financially viable. The third component to a successful project is organisation. The skills, competency, experience and potential outreach of the organisation are critical. There must be a clear goal – a point of completion.

Why have we struggled to produce some vaccines in the past despite substantial investment?

Investment has mostly taken place in the developed world. This does not reflect the areas where the burden of diseases such as TB, malaria and HIV are highest. Therefore vaccines have been developed largely for the needs of the developed world. The issues of access and affordability have not been addressed. There is a clear difference in equity in the developed world and developing world.

In terms of why investment has not directly yielded results is largely because the research is inherently “risky.” There is no real guarantee of success. HIV, malaria, TB are extremely complex diseases meaning we are still unsure which strategy to use when developing vaccines.

Which diseases or approaches are currently neglected?

This includes some of the world’s tropical diseases such as Dengue, Chagas Disease and Leishmaniasis. Respiratory and diarrhoeal diseases are also a major health burden in the developing world with few affordable vaccines available. This will include pneumococci, rotavirus and other gastroenteritis-causing organisms.

In terms of approaches that are neglected, I would say the technical aspects, such as altering the formulation, packaging and delivery method, have been overlooked in the past. The current methods are not optimized for the developing world. For instance, Rotavirus Vaccine licenced in 2006 is in liquid form and needs to be refrigerated in order to thermostabilise the vaccine. If delivery methods can be improved the costs could be kept very low.

What are the main goals of Hilleman Laboratories and what makes it such a good project?

Our goal is to bridge the translational gap between research and development of vaccines to suit the needs of the developing world. We have a unique and strong 50:50 partnership between the Welcome Trust and Merck. Also, by being based in India we have a strong infrastructure to leverage, because the country has a long tradition of actually making vaccines. At the moment we are still in preclinical research but aim to test our products in clinical trials by next year.

What benefit would the vaccines you plan to develop offer?

The main obstacle to the access of vaccines in the developing world is pricing. The vaccines for such diseases (as mentioned above) cannot be afforded by the developing world. Despite organisations such as GAVI subsidising the prices from $50 to about $5 a dose, this is still unaffordable for the broader needs of the developing world. Hopefully, the optimised vaccine will reduce the cost to $1 a dose or less. This saved procurement cost would be added to the saved distribution cost of vaccines by reducing wastage.

Vaccines need to be kept cold otherwise their effectiveness can be reduced a lot and their shelf life is shortened. Vaccines cannot be adequately stored in the cold in tropical climates where transport is difficult. Therefore a thermostable vaccine would impact to reduce the cost dramatically. These reduced expenses for delivery and disposal would reflect in the price of the vaccine. By being manufactured in the developing world the operational cost would also be kept low, allowing the price of the vaccine to be affordable.

What are the pitfalls such research can fall into?

The obstacles include timing. It is important that stakeholders, that will be crucial in the implementation of the vaccine, are brought into the development and conversations early on. Not being fast enough to deal with local agencies, government and distribution could hinder progress. This is because we would be in a situation where technically the problem of vaccine design is solved but we would have no one to take on the vaccine to adapt and implement it.

What is the future for Hilleman Laboratories?

Hilleman Laboratories has a strong and committed mission to address the major needs in global health. As a strong partnership and as a global company we are well-connected to global health policy makers and agencies. Our collaborative model, network and technical innovation provides us with the resources to make our long term goals successful.

Rob Wiblin

Project Healthy Children: a promising opportunity for leverage

We are excited to announce that for the first time in a while, Giving What We Can is changing its recommendations! Below we describe what is happening and answer some natural questions that flow from that.

What is happening with our recommendations?

We are splitting our recommendations into two different categories, and adding a new one to the list - 

AMF and SCI will become our ‘High-confidence recommendations’. They have been vetted extensively by GiveWell, and have a high probability of achieving a lot of good with your money.

Project Healthy Children and Deworm the World will be classified as ‘Opportunities for leverage’. There are two reasons to separate them in this way: their projects have not been scrutinised in the same level of detail as AMF and SCI, and by its nature their approach - influencing health policies in developing countries - is harder to concretely evaluate. If successful, both might achieve more good per dollar than AMF and SCI. However, it is hard to know how likely they are to do so.

We are also going to list other organisations such as

We regard this as a very promising opportunity and more information will be forthcoming in the near future.

We are writing a short report on AidGrade, and will likely have more to say about them in future as their project matures.

We are at an early stage, collecting information on the fundamental cost effectiveness of their work.

Those we have looked at in the past, and a brief assessment of where we stopped 

Global Network for Neglected Tropical Diseases

Project Healthy Children sends experts to low-income countries, now exclusively in sub-Saharan Africa, to hasten and increase the quality of mandatory micronutrient fortification of staple foods such as wheat and maize flour, sugar and oil. They place advisors within recipient governments to offer encouragement, coordination across agencies and technical assistance, depending on what is required to push fortification standards forwards.

A significant fraction of people in recipient countries experience worse health due to insufficient intake of iron, vitamin A, iodine, zinc and folic acid. These deficiencies cause the greatest harm in children and pregnant mothers. Ensuring that commonly-consumed foods contain these nutrients should improve population health.

What are some promising things about Project Healthy Children?

They are promoting an approach - micronutrient fortification of staple foods - that costs very little per person reached, typically under $0.30 per year for ongoing fortification with the most important nutrients. Micronutrient intake is regarded as a top priority health issue for the developing world by the 

Increased micronutrient consumption is highly likely to reduce the severity of deficiency.

They have operated, and probably will continue to operate, in countries with high levels of micronutrient deficiency.

They operate on a tight budget. A single member of staff lives in each country for 3-6 years and is paid a modest income. This individual, with support from two central staff members in the US, can run a full country program to completion for only a few hundred thousand US dollars.

If they achieved a comprehensive national mandatory fortification scheme in any given country, this would affect millions of people. The cost to PHC per person reached with fortified foods per year would be in the order of 1 cent.

We have spoken with four contacts in affected countries who have had dealings with PHC. Their names were provided by a technical fortification expert recommended by PHC. All had a positive view of the competence of PHC staff, felt they were filling a useful gap not filled by other organisations, and were respected and appreciated by recipient governments.

We have heard that some of the countries PHC has operated in, or are considering opening new offices is, are not yet making progress on food fortification.