Thank you all for you kind donations to The Against Malaria Foundation last week, together we were able to donated a grand total of 165 bed nets. I think this (and by association, you) is (are) amazing, and I hope that you think so too! In the spirit of last weeks post I want to talk about the lives behind the numbers and demonstrate the impact that your donations will have.
The Against Malaria Foundation (AMF) holds a very special title, they have been ranked as the top charity on the charity evaluator GiveWell since 2014. This means that donating to AMF currently represents one of the best opportunities to help people in low income countries with a high degree of certainty.
We all want our donations to go to good use, but rarely do we conduct rigorous economic analysis into the cost-effectiveness of the charities we donate to. GiveWell is a meta-charity (charity about charity) that does exactly that. Their research determines which charities are currently best placed to do the ‘most good’* so as to help your donations go further.
Effectiveness
When thinking about the effectiveness of charities it is often tempting to think about how many staff the charity employs, how much they spend on office supplies or how much they paid their CEO.
These factors are important but personally this (see below) is how I like to see charity. A black box I can feed money and that spits out lives of free from death and disease (with the addition that the black box actively avoids cause harm to others).
Measuring the effectiveness of a charity allows for comparison with other charities that may appear, from the outside, equally worthy. It's never perfect, and assumptions will always have to be made, but it works well if your aim is to improve the amount of good your donations can do. I am no expert on cost effective analysis but GiveWell is, so I trust in their recommendations.
The reason AMF is rated so highly is due to the strong evidence behind the intervention that they facilitate.
Long Lasting Insecticide-Treated Nets
AMF do one thing and they do it spectacularly well, they distribute Long Lasting Insecticide-Treated Nets (LLIN’s) to protect communities from mosquitos carrying the malaria parasite.
The brilliant thing about these nets is that not only do they offer a durable physical barrier against mosquitos, but the insecticide (which is harmless to humans) repels or kills the mosquitos that tries to penetrate it. This means that those under the nets are protected by the barrier it creates and, occasionally, the net take a malaria carrying mosquito out of the sky for good, insuring that they don’t infect anyone else. Thus the nets are able to provide a small community benefit as well [1], similar to that of herd immunity found with vaccines.
These nets are each large enough for an entire family to sleep under, but for sake of working out the impact of our donations let's assume that each net we bought would be used by one or two individuals (i.e. 1.5 per net).
AMF operate under a 8%-20%-50% model for their nets whereby they estimate that 8% of nets will be out of use in the first year (and need replacing), 20% will be out of use in the second year and 50% will be out of use in the third year. For ease let's say that everyone that gets our nets will cherish them, use them for the purpose they were intended for** and no random disastrous event will befall them. This then mean that our donations will have potentially given 248 individuals a high level of protection from malaria for three years.
The impact of our donations based on the efficacy of LLIN’s
The term efficacy refers to how well an intervention works under controlled conditions (i.e. the findings from academic studies that measure the intervention). To date there have been two Cochran reviews of LLIN’s as an intervention, one that focuses on general use of LLIN’s[2] and the other on the impact of their use to prevent malaria during pregancy [3].
From the first systematic review (which combined the data of 22 randomised control trials) the author suggests that approximately 5.53 lives can be saved each year for every 1000 children protected by the mosquito nets.
Let’s run with this finding.
AMF aim for universal coverage (rather than targeted coverage), so the first issue we come to is that not all of the individuals sleeping under our nets will be children. Malaria, thankfully, is less deadly for individuals over 5 years of age. From what I can tell GiveWell estimates it takes around 3 times more nets before one >5 years of age life is saved (1.66 lives for every 1000 >5 year old covered)
According to the population distribution of Sub-Saharan Africa (the location our nets are more likely to go) around 8.2% of the population is below 5 years of age. Lets bump this up to 20% of our net going to this age group as if a family/community has a limited supply of nets I’m going to go ahead and assume that they will prioritise the child over themselves or older children.
So for our nets that’s around 50 children and 200 older children and adults we’re protecting.
Our donations therefore, based on the rates given, save 0.597 lives per year for three years.
Or in other words, we will have prevented enough malaria that someone that would have died from it now won’t, and another has a 50/50 chance of avoiding it***.
The impact of our donations based on the estimate by GiveWell
The above is very much a back of the envelope calculation of our impact. It’s rough but not a million miles away from the more conservative expected value of donations to AMF suggested by GiveWell in their current cost effectiveness model.
A usual advertising campaign will say that “your donation could save a child for as little as...“ GiveWell aims to change this to a “your donation does save a child for as little as…”
This is why I want to end by suggesting that you consider setting up a standing order donation to The Against Malaria Foundation. If you were to commit to £45 per month in five years you will have, with a high level of certainty, saved a life.
In my opinion, one of the most loving and altruistic things we can do in life is to critically consider what our income is actually worth and act with an aim of having it help others. Donating based on such thinking may not necessarily cause the warm fuzzy feelings that are often associated with giving to a charity you feel emotionally attached to, but giving effectively will ultimately leave us all better off in the long run.
You're still reading! Amazing, I would have given up long ago.
If you didn't totally hate this post I have others that you might not totally hate too. Check them out, and if this is something you'd like to not hate seeing more of in the future give me a follow and say hi.
I'm terrible at naming posts, they often don't give a good indication of what they include
World Malaria Day: If I look at the many I will never act This post looks at the consept of scope neglect and how we struggle to feel empathy and act on it when the number of those suffering gets higher.
Hey, so Effective Altruism is a thing This post includes a number of links that gives a basics overview of Effective Altruism.
A wedding by the shallow streamThis post is about a thought experiment that kicked me in the gut a few years ago and started me down a path of trying to help in whatever way I can.
Footnotes:
*Subjective I know. Often when I talk about doing the ‘most good’ on this blog I'm going to be talking in terms of DALY’s or QALY’s a means of taking into account years lost to a disability and years of life lost due to death before life expectancy. For more on this and a discussion on the subjectivity of doing good see Will MacAskill’s book Doing good better
**Occasionally nets are used for fishing. This is potentially a cause for concern, mostly due to the unknown affect the insecticide may have on the ecosystem in the long term. Lots of discussion has centered on selling the nets at a subsidised rate to promote value however better usage and outcomes are still linked to giving away the nets for free.
***Do you disagree with this? Good you should, I’m bad at economic analyses. Luckerly all the information is out there in the open for anyone to use, here is likely a good starting point. If anyone wants to make an “um actually I think you’ll find…” comment below pointing out all the mistakes/bad assumptions I’ve made, excellent please please do!
References:
[1]: Levitz L, Janko M, Mwandagalirwa K, Thwai KL, Likwela JL, Tshefu AK, Emch M, Meshnick SR. Effect of individual and community-level bed net usage on malaria prevalence among under-fives in the Democratic Republic of Congo. Malaria journal. 2018 Dec;17(1):39.
[2]: Gamble CL, Ekwaru JP, ter Kuile FO. Insecticide‐treated nets for preventing malaria in pregnancy. The Cochrane Library. 2006 Apr.
[3]: Lengeler, C. (2004). Insecticide‐treated bed nets and curtains for preventing malaria. The Cochrane Library.