Sources
Footnotes
[1] "The World Health Organization (WHO) defines seasonal malaria chemoprevention as 'the intermittent administration of full treatment courses of an antimalarial medicine to children during the malaria season in areas of highly seasonal transmission.' It 'consists of administering a maximum of four treatment courses of SP [sulfadoxine–pyrimethamine] + AQ [amodiaquine] at monthly intervals to children aged 3–59 months in areas of highly seasonal malaria transmission' and 'during the high malaria transmission period.'" GiveWell: Seasonal Malaria Chemoprevention, October 2018, "What is the program?"
[2] "Campaigns for seasonal malaria chemoprevention should continue." World Health Organization: "Community-based health care, including outreach and campaigns, in the context of the COVID-19 pandemic: Interim guidance," May 5, 2020, Pg. 34
- "Malaria Consortium supports training of health facility workers and community distributors (CDs) to deliver treatments primarily by going door-to-door." GiveWell: Malaria Consortium – Seasonal Malaria Chemoprevention, November 2019, "Malaria Consortium SMC implementation methods"
- "On the margin, Malaria Consortium expects to use additional funding to:
- "Continue funding seasonal malaria chemoprevention (SMC) in four countries: Nigeria ($11.6 million), Burkina Faso ($11.3 million), Chad ($10.2 million), and a fourth, to-be-determined country ($2.5 million)." GiveWell: Top Charities' Room for More Funding, November 2019
[4] "Across the Sahel, most malaria illness and deaths occur during the rainy season, typically between July and October. Seasonal malaria chemoprevention (SMC) is a highly effective intervention to prevent malaria infection during this peak transmission period among those most at risk: children under five." Malaria Consortium: "Our SMC programme"
- "Personal protective equipment: as long as supplies are available, all community distributors will be provided with the requisite equipment to protect them and beneficiaries when they are in close contact. This includes masks and gloves. We are also providing them with disinfecting solution, soap, jerry cans for water, biowaste bags, and additional shirts and hijabs to allow for frequent washing." Malaria Consortium: "Keeping SMC beneficiaries and distributors safe during COVID-19"
- Malaria Consortium slightly updated the items to be provided to distributors in unpublished comments on drafts of this blog post, dated June 13 and June 16.
[6] "7. Practice safe distance of 2 metres with caregivers and children at all times.
"8. Determine what the caregiver knows about COVID-19 and explain why you are wearing a mask and why physical distance of 2 metres must be maintained.
"9. Explain to caregivers that your materials have been disinfected and the importance of community members washing hands with soap and water frequently."
[7] Some of Malaria Consortium's costs will be reduced due to operational changes. For example, it plans to reduce its meetings for training of trainers, planning, and review, or to hold them remotely. However, on balance, it expects higher costs due to the changes it will implement to mitigate the spread of COVID-19. Malaria Consortium conversation with GiveWell, April 9, 2020 and Malaria Consortium comments to GiveWell on draft blog post, June 13, 2020
[8] GiveWell room for more funding analysis for Malaria Consortium's SMC program (Q2 2020_Covid19), "Spending opportunities" tab, cell S3.
[9] See the "SMC" tab, row 87, of our latest cost-effectiveness model here. "Malaria-attributable deaths averted with hypothetical donation ($100,000) in treated and untreated populations (after internal and external validity adjustments)" = 43.5. $100,000/43.5 = $2,299. We express our cost-effectiveness estimate as a range ($2,000 to $3,000) to reflect the level of precision we believe it has. There are limitations to this kind of cost-effectiveness analysis, and we believe that cost-effectiveness estimates such as these should not be taken literally, due to the significant uncertainty around them. We provide these estimates (a) for comparative purposes and (b) because working on them helps us ensure that we are thinking through as many of the relevant issues as possible.
[10] "Community-based surveys, mass treatment and active case finding should be temporarily suspended." World Health Organization: "Community-based health care, including outreach and campaigns, in the context of the COVID-19 pandemic: Interim guidance," May 5, 2020, Pg. 33
[11] "The World Health Organization recommends annual treatment for schistosomiasis and twice-annual treatment for soil-transmitted helminths for preschool- and school-aged children in areas with prevalence above 50%. In areas with lower prevalence, the World Health Organization recommends less frequent deworming." See "How often do people need to be treated?" in our intervention report "Combination Deworming (Mass Drug Administration Targeting Both Schistosomiasis and Soil-Transmitted Helminths)," first published in December 2013, last updated in January 2018.
[12] Our impression from recent conversations with Sightsavers and SCI Foundation is that some treatment campaigns these organizations have scheduled for late 2020 or early 2021 may be unaffected (Sightsavers, conversation with GiveWell, June 24, 2020, and SCI Foundation, conversation with GiveWell, April 8, 2020). Deworm the World Initiative has told us that some deworming treatments scheduled for summer 2020 have been cancelled or delayed, while others may be carried out as scheduled (Deworm the World Initiative, conversation with GiveWell, May 4, 2020).
[13] GiveWell back-of-the-envelope estimate of COVID-19's impact on deworming charities' cost-effectiveness over three years, "Impact on cost-effectiveness" tab, column D.
[14] We made a number of simplifying assumptions in our back-of-the-envelope cost-effectiveness estimate:
- We framed the question as: “Assuming that one year of deworming is skipped due to COVID-19, what is the cost-effectiveness of deworming programs over three years?” We typically fund over a three-year time horizon, but the choice of one year here is somewhat arbitrary because we do not feel well positioned to guess how long deworming programs will be paused due to the pandemic.
- We made assumptions about which costs will continue while programs are paused ("fixed") and which will be saved ("variable"), but we haven't checked these with the charities. We think it is unlikely that having more precise information would significantly change the bottom line.
- We are least confident in our estimate of the END Fund's spending. We don't think that refining this estimate would change the 10-25% range across the four organizations.
[15] We refer to this as "our grant" for simplicity in this section; however, funding for the grant was provided by donors to the Effective Altruism Global Health and Development Fund. This funding was allocated to IGI at the recommendation of GiveWell.
[16] "As part of GiveWell’s exploratory work into opportunities to improve the uptake and implementation of evidence-based policy by governments, in December 2018, GiveWell recommended the Effective Altruism Global Health and Development Fund make a grant of $1,000,000 to J-PAL’s Innovation in Government Initiative (IGI)." GiveWell: Innovation in Government Initiative — General Support, January 2019, "Summary"
- "IGI intends to use this grant to partially fund its operating expenses, and to run two RFPs focused primarily on Type 2 scale ups over the course of two years." GiveWell: Innovation in Government Initiative — General Support, January 2019, "How will the grant be used?"
- "Type 2: Technical assistance to scale up policies which have been evaluated by a randomized controlled trial (RCT)." GiveWell: Innovation in Government Initiative — General Support, January 2019, "The organization"
- IGI's first RFP closed to applications on September 20, 2019 (GiveWell's non-verbatim summary of a conversation with Samantha Carter and Claire Walsh, August 14, 2019). IGI's second RFP closed this spring: "IGI's Spring 2020 scale-up innovation competition is now closed. Funding decisions will be announced at the end of June" (J-PAL Scale-up Innovation Competition, "Proposal Timeline").
- IGI told us it had $450,000 remaining from GiveWell's 2018 grant and that it was interested in using around one-third of that amount for COVID-19 grants, though it was very uncertain about the total needed. Claire Walsh, Senior Policy Manager at J-PAL, and Gaëlle Conille, Policy Associate at J-PAL, call on April 1, 2020
- "IGI is immediately accepting time-sensitive, off-cycle proposals for up to US$25,000 for short-term, quick response technical assistance and/or analysis for government partners that has the potential to mitigate the spread and/or consequences of the COVID-19 pandemic in low- and middle-income countries, particularly for low-income and other vulnerable communities…. This includes projects that ultimately aim to:
- "Reduce COVID-19’s spread and/or increase adoption of WHO-recommended prevention behaviors like handwashing and social distancing
- "Reduce COVID-19’s broader consequences on human health and well-being, including economic and social costs for individuals, families, workers, and businesses, for example by increasing access to or take-up of social protection programs like cash transfers, unemployment assistance, assistance to small businesses, free preventive health products and services, health insurance, telemedicine, etc. "
J-PAL Innovation in Government Initiative: COVID-19 Off-Cycle Window, March 20, 2020
[19] "Operations are live in 2 countries, with 5 more to come." GiveDirectly COVID-19 Response Africa
See also GiveDirectly Project 100: Donate to COVID-19 Cash Relief Fund for work in the United States.