Published: November 2020; Updated April 2021
- Give effectively
- Cost to save a life
- Medicine to prevent malaria
- Nets to prevent malaria
- Supplements to prevent vitamin A deficiency
- Cash incentives for routine childhood vaccines
- Treatments for parasitic worm infections (deworming)
- Cash transfers for extreme poverty
GiveWell has 15 full-time research staff. The names and roles of research staff can be found here.
Each research staff member contributes about 2,000 hours per year (46 weeks at 40 hours per week). We assume that one-quarter of their time is spent on non-research work, such as staff meetings. We thus roughly estimate that they collectively conduct more than 20,000 hours of research per year (15 staff multiplied by 2,000 hours per year multiplied by 75% of time on research).
Cost to save a life
Our estimate of the cost to save a life is based on our cost-effectiveness model. This model does not yet include estimates for New Incentives; you can find those in our cost-effectiveness model for New Incentives.
You can read more about our approach to estimating cost-effectiveness and its role in our decisions about what to fund and recommend to donors here. Explicit cost-effectiveness estimates are a major, but not the only, input into our decision-making process. More on the principles we use in decision-making here.
We present cost-effectiveness estimates as a range rounded to the nearest thousand dollars on our Top Charities page. This reflects the degree of precision we believe our model can estimate, as well as the range of cost-effectiveness that charities are likely to achieve across the countries they work in. Charities' cost-effectiveness can vary widely by geography, depending on the underlying burden of disease and the costs of operating in a given country.
Why is the cost to save a life so much higher than the cost per net/treatment?
We often get questions about why we estimate it costs $3,000 to $5,000 to save a life if, for example, it only costs approximately $5 to distribute a malaria net, or $7 to distribute antimalarial medicine, or $1 to provide a vitamin A supplement—the interventions we recommend to save lives. It's not intuitive!
Here, we'll briefly walk through why our estimate of the cost to save a life is higher than our estimate of the cost per treatment or item. We'll use the example of the Against Malaria Foundation (AMF), a GiveWell top charity.
AMF supports the distribution of insecticide-treated nets to prevent malaria. These nets are hung over sleeping spaces and block and kill malaria-carrying mosquitoes. We estimate that it costs about $5 to purchase and distribute one of these nets.1
Not every person who receives a net from an AMF-supported distribution would have otherwise died of malaria. This is why the cost per life saved is not $5.
In addition, although the nets are highly effective, the nets do not prevent malaria 100% of the time. They wear out over time, developing holes that reduce their effectiveness.2 In addition, mosquitoes have developed some resistance to the insecticide that the nets are treated with, also reducing the nets' effectiveness.3 In addition to factors related to the nets themselves, some people will choose not to use their nets, will not use them consistently, or may use them incorrectly (for example, leaving gaps between the net and their sleeping space).4 People can also be bitten by infected mosquitoes when they are not in bed.5 We adjust our estimate of nets' effectiveness against malaria to account for these factors.
We also incorporate the local malaria mortality rates where AMF works. While nets are distributed to people who are at risk of malaria, even without nets a fairly small portion of them would die due to the disease. Many would, by chance, avoid infection. Many who do get infected would survive the infection with treatment or without. We estimate the cost per life saved for each location based on the likelihood that a person who receives a net would have died from malaria without the net.6
In addition, we include whether we believe that other actors would distribute nets if AMF didn't, so that we can estimate AMF's true impact—and thus our best guess of the true impact of donations to AMF. 7
When we take these and many other factors into account, we come to our all-in estimate of the true cost to save a life by donating to AMF: $3,000 - $5,000. You can see our full calculation here. It may sound high, but it's one of the most cost-effective programs we've ever found.
Medicine to prevent malaria
Impact of malaria
Estimates of annual malaria deaths vary from about 410,000 to 640,000.8 At least 90% of the malaria deaths reported by the World Health Organization (WHO) for 2019 were in sub-Saharan Africa, and children under five years old accounted for about two-thirds of malaria deaths globally.9
Presuming the proportion of children dying from malaria is approximately constant across countries, then about 60% of total malaria deaths were children under 5 years old in sub-Saharan Africa (90% of total malaria deaths in sub-Saharan Africa multiplied by 67% of total malaria deaths occurring in children under five).
Cost of providing medicine to prevent malaria
We estimate that seasonal malaria chemoprevention delivered by Malaria Consortium costs $6.59 per child.
Nets to prevent malaria
Cost of providing nets
We estimate that nets delivered by Against Malaria Foundation cost $4.95 each.
Supplements to prevent vitamin A deficiency
Impact of vitamin A deficiency
The Institute for Health Metrics and Evaluation's Global Burden of Disease project estimates that vitamin A deficiency increases the risk of diarrhea, measles, and lower respiratory tract infections.10 In 2017, an estimated 233,000 global deaths were linked to this increased risk.11
Cost of providing vitamin A supplementation
We estimate that vitamin A supplementation delivered by Helen Keller International costs $1.10 per child.
Cash incentives for routine childhood vaccines
Impact of vaccine-preventable diseases
Cost of providing vaccine incentives
We estimate that, on average, the total cost to immunize one child through New Incentives' program is $47.
Treatments for parasitic worm infections (deworming)
Impact of parasitic worms
Many types of parasitic worms infect human beings, causing illnesses including schistosomiasis and soil-transmitted helminthiasis. Hundreds of millions of people have these infections.14
Cost of deworming
The median cost per person dewormed per year by our four deworming top charities as of 2019 is $0.97; thus, $100 would cover deworming efforts for approximately 100 children.
Impact of deworming
Some studies indicate that reducing worm infection loads during childhood can have a significant later impact on income during adulthood. There is a possibility that deworming children has a subtle, lasting impact on their development and thus on their ability to be productive and successful throughout life. However, there is less research on the developmental impacts of deworming than on the interventions of our other top charities, so we are more uncertain about it. Our estimate of the impact of deworming—a cumulative $1,076 in additional earnings over the course of 100 children's lives—accounts for this uncertainty.
Income of those receiving deworming treatment
Our four top deworming charities work in the following countries: India, Kenya, Pakistan, Nigeria, Ethiopia, Malawi, Mozambique, Democratic Republic of Congo, Madagascar, Tanzania, Côte d'Ivoire, Zambia, Liberia, Guinea, Guinea-Bissau, Cameroon, Angola, Rwanda, and Zimbabwe.15 According to the World Bank's PovcalNet data, the median per capita consumption per year across the geographic areas supported by our four top deworming charities is $706.
Cash transfers for extreme poverty
According to Our World in Data’s analysis of the World Bank’s PovcalNet data, about 62% of the world’s population in 2017 had per capita consumption of $10 per day or less ($3,650 per year or less).16
Efficiency of GiveDirectly
Cash grants make up 83% of GiveDirectly’s all-time expenses.
"We estimate that on average the total cost to purchase, distribute, and follow up on the distribution of an AMF-funded LLIN is $4.95. Excluding in-kind government contributions, we estimate the cost is $4.65.." GiveWell: Against Malaria Foundation, section on "Cost per LLIN distributed."
- "Post-distribution net loss occurs for multiple reasons: attrition (i.e., nets were discarded due to damage, appropriated for other uses, given away, moved, or stolen), extensive holes in the net that make it permeable to mosquitoes, and decay of the net's insecticide component to the point that it is no longer effective." GiveWell: Estimating Equivalent Coverage Years for Long-Lasting Insecticide-Treated Nets (LLIN), section on "Measuring Net Durability."
- Our estimate of the duration of insecticide-treated nets is incorporated into our cost-effectiveness model here: GiveWell: 2020 GiveWell cost-effectiveness analysis — version 2, "AMF" sheet, cell A30.
- "Insecticide resistance (defined broadly as any ways in which populations of mosquitoes adapt to the presence of insecticide-treated nets (ITNs) in order to make them less effective) is a major threat to the effectiveness of ITNs." GiveWell: Insecticide Resistance and Malaria Control.
- We adjust our cost-effectiveness model to account for insecticide resistance here: GiveWell: 2020 GiveWell cost-effectiveness analysis — version 2, "AMF" sheet, cell A57.
- "We define LLIN coverage as the proportion of people living in households that were targeted by an AMF distribution who subsequently sleep under LLINs, thereby benefiting from the protective effect against malaria. . . . With one exception, the PDMs [post-distribution monitoring studies] we focus on have found reported coverage rates of between 75% and 90%." GiveWell: Against Malaria Foundation, section on "What proportion of targeted recipients use LLINs over time?"
- "Interestingly, nets with no holes had an average of just over one mosquito per net. Presumably, this was due to improper usage and residents should be instructed on how to tuck their nets in to prevent mosquitoes from entering them." Ochomo et al. 2013, pg. 7.
- We adjust our cost-effectiveness estimate for net use here: GiveWell: 2020 GiveWell cost-effectiveness analysis — version 2, "AMF" sheet, cell A53.
For example, one study found that ITNs are less effective in some locations, such as Myanmar, "where the principal malaria vectors bite outdoors early in the evening, before people go in or near their ITN." GiveWell: Mass Distribution of Long-Lasting Insecticide-Treated Nets (LLINs), section on "How might the effectiveness of ITNs vary across settings with different malaria transmission patterns?," footnote 45.
- "We use data on malaria incidence and mortality in the countries where AMF works in our cost-effectiveness model. We compare these data to malaria rates in the populations targeted in RCTs, then account for differences in these populations by adjusting the effects measured in RCTs to estimate the impact of LLINs on malaria rates in the countries where AMF works." GiveWell: Against Malaria Foundation, section on "Are LLINs targeted at areas with high rates of malaria?"
- We adjust for the differences between malaria mortality in the countries where AMF works and the malaria mortality in the populations targeted in the RCTs here: GiveWell: 2020 GiveWell cost-effectiveness analysis — version 2, "AMF" sheet, cell A56.
- For our analysis of malaria incidence and mortality, see GiveWell: 2020 GiveWell cost-effectiveness analysis — version 2, "AMF" sheet, sections on "Age distribution of net coverage," "Mortality reduction in children under 5," and "Mortality reduction in individuals 5+ years old."
Our adjustments for the possibility that other actors may distribute nets in the absence of AMF can be found here: GiveWell: 2020 GiveWell cost-effectiveness analysis — version 2, "AMF" sheet, cells A201:A212.
The Global Burden of Disease (GBD) project estimates more than 640,000 global deaths from malaria in 2019. “Measure: Deaths, 2019 number: 643,380.9.” Institute for Health Metrics and Evaluation, Global Burden of Disease, GBD Compare, Global malaria deaths. The World Health Organization (WHO) estimates approximately 409,000 malaria deaths in 2019. “Globally, malaria deaths have reduced steadily over the period 2000–2019, from 736 000 in 2000 to 409 000 in 2019.” WHO, World Malaria Report 2020, Pg xv.
WHO, World Malaria Report 2020, Pg 21, Figure 3.2d. For the list of countries in sub-Saharan African, see United Nations Development Programme, "About sub-Saharan Africa". “The percentage of total malaria deaths among children aged under 5 years was 84% in 2000 and 67% in 2019.” WHO, World Malaria Report 2020, Pg xv.
"In its Global Burden of Disease (GBD), IHME models VAD [vitamin A deficiency] as both a direct cause of years lived with disability (YLDs) and as a risk factor for three other diseases (diarrheal diseases, lower respiratory tract infections (LRTIs), and measles)." GiveWell's non-verbatim summary of a conversation with the Institute for Health Metrics and Evaluation, April 5, 2019
The GBD project attributes 233,000 deaths to "Vitamin A deficiency: all causes" in 2017. GBD 2017 Risk Factor Collaborators, 2018, p. 1948.
"In 2019, global coverage rates for the third dose of the diphtheria, tetanus and pertussis vaccine (DTP3) reached 85 per cent." This vaccine is "often used as an indicator of how well countries are providing routine immunization services." UNICEF, "Immunization," 2020. We say “at least” because coverage tends to be lower for other vaccines. For global vaccination rates, see Our World in Data, Global vaccination coverage, World, 2019.
In 2019, 57% of infants in Nigeria received the third dose of the diphtheria, tetanus, and pertussis vaccine. Our World in Data, Global vaccination coverage, Nigeria, 2019
According to the Global Burden of Disease (GBD), global prevalence of cases of intestinal worms in 2019 is as follows: schistosomiasis, 140.0 million; hookworm disease, 172.5 million; trichuriasis, 360.3 million; and ascariasis, 445.6 million. Institute for Health Metrics and Evaluation, Global Burden of Disease, GBD Results tool, Global parasitic worm infection prevalence.
See the locations listed in row 1 of the "Deworm the World", "SCI Foundation", "END Fund", and "Sightsavers" sheets in the 2020 GiveWell cost-effectiveness analysis — version 1.
“37.65% above $10/day, 2017.” Rosen and Ortiz-Ospina, 2019, Distribution of population between different poverty thresholds, World, 1981 to 2017.