Aggregator

Intermittent preventive treatment in infants (IPTi) for malaria provides preventive antimalarial medicine to children under 12 months old. It is among the most promising programs we've identified in our active pipeline of new interventions. It's also underutilized, and the population it targets is especially vulnerable to malaria. That implies potential to open up large amounts of room for more funding if IPTi begins to be used more widely—our crude estimate is between $50 million and $200 million globally once it's scaled—which is something we're increasingly thinking about as we aim to direct $1 billion in cost-effective funding by 2025. In September 2021, we recommended a small grant to Malaria Consortium and PATH to assess the feasibility and cost-effectiveness of implementing IPTi at national scale in two countries. We're hopeful that this scoping exercise will answer some of our many open questions about IPTi, and that this intervention continues to look promising as we learn more.

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The post IPTi for malaria: a promising intervention with likely room to scale appeared first on The GiveWell Blog.

Our goal with hosting quarterly open threads is to give blog readers an opportunity to publicly raise comments or questions about GiveWell or related topics (in the comments section below). As always, you’re also welcome to email us at info@givewell.org or to request a call with GiveWell staff if you have feedback or questions you’d prefer to discuss privately.

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The post December 2021 open thread appeared first on The GiveWell Blog.

Our goal with hosting quarterly open threads is to give blog readers an opportunity to publicly raise comments or questions about GiveWell or related topics (in the comments section below). As always, you’re also welcome to email us at info@givewell.org or to request a call with GiveWell staff if you have feedback or questions you’d prefer to discuss privately.

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The post December 2021 open thread appeared first on The GiveWell Blog.

For this post, a number of GiveWell staff members volunteered to share the thinking behind their personal donations for the year. We've published similar posts in previous years. (See our staff giving posts from 2020, 2019, 2018, 2017, 2016, 2015, 2014, and 2013.) Staff are listed alphabetically by first name.

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The post Staff members’ personal donations for giving season 2021 appeared first on The GiveWell Blog.

For this post, a number of GiveWell staff members volunteered to share the thinking behind their personal donations for the year. We've published similar posts in previous years. (See our staff giving posts from 2020, 2019, 2018, 2017, 2016, 2015, 2014, and 2013.) Staff are listed alphabetically by first name.

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The post Staff members’ personal donations for giving season 2021 appeared first on The GiveWell Blog.

You can have a remarkable impact by supporting cost-effective, evidence-based charities.

Just looking at the approximately $100 million GiveWell had discretion to grant in 2020—a subset of all the money we directed to the charities we recommend—the impact of our donors is impressive. We estimate these grants will:

• Save more than 24,000 lives
• Treat over 6 million children with a full course of antimalarial medication
• Provide vitamin A supplementation to over 8.6 million children
• Deliver over 4.4 million long-lasting insecticide-treated nets (LLINs) to protect against malaria
• Vaccinate 118,000 children
• Treat over 11.4 million children for parasitic worms

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The post Our recommendations for giving in 2021 appeared first on The GiveWell Blog.

You can have a remarkable impact by supporting cost-effective, evidence-based charities.

Just looking at the approximately $100 million GiveWell had discretion to grant in 2020—a subset of all the money we directed to the charities we recommend—the impact of our donors is impressive. We estimate these grants will:

• Save more than 24,000 lives
• Treat over 6 million children with a full course of antimalarial medication
• Provide vitamin A supplementation to over 8.6 million children
• Deliver over 4.4 million long-lasting insecticide-treated nets (LLINs) to protect against malaria
• Vaccinate 118,000 children
• Treat over 11.4 million children for parasitic worms

Read More

The post Our recommendations for giving in 2021 appeared first on The GiveWell Blog.

You can have a remarkable impact by supporting cost-effective, evidence-based charities.

Just looking at the approximately $100 million GiveWell had discretion to grant in 2020—a subset of all the money we directed to the charities we recommend—the impact of our donors is impressive. We estimate these grants will:

• Save more than 24,000 lives
• Treat over 6 million children with a full course of antimalarial medication
• Provide vitamin A supplementation to over 8.6 million children
• Deliver over 4.4 million long-lasting insecticide-treated nets (LLINs) to protect against malaria
• Vaccinate 118,000 children
• Treat over 11.4 million children for parasitic worms

Read More

The post Our recommendations for giving in 2021 appeared first on The GiveWell Blog.

You can have a remarkable impact by supporting cost-effective, evidence-based charities.

Just looking at the approximately $100 million GiveWell had discretion to grant in 2020—a subset of all the money we directed to the charities we recommend—the impact of our donors is impressive. We estimate these grants will:

• Save more than 24,000 lives
• Treat over 6 million children with a full course of antimalarial medication
• Provide vitamin A supplementation to over 8.6 million children
• Deliver over 4.4 million long-lasting insecticide-treated nets (LLINs) to protect against malaria
• Vaccinate 118,000 children
• Treat over 11.4 million children for parasitic worms

Read More

The post Our recommendations for giving in 2021 appeared first on The GiveWell Blog.

You can have a remarkable impact by supporting cost-effective, evidence-based charities.

Just looking at the approximately $100 million GiveWell had discretion to grant in 2020—a subset of all the money we directed to the charities we recommend—the impact of our donors is impressive. We estimate these grants will:

• Save more than 24,000 lives
• Treat over 6 million children with a full course of antimalarial medication
• Provide vitamin A supplementation to over 8.6 million children
• Deliver over 4.4 million long-lasting insecticide-treated nets (LLINs) to protect against malaria
• Vaccinate 118,000 children
• Treat over 11.4 million children for parasitic worms

Read More

The post Our recommendations for giving in 2021 appeared first on The GiveWell Blog.

You can have a remarkable impact by supporting cost-effective, evidence-based charities.

Just looking at the approximately $100 million GiveWell had discretion to grant in 2020—a subset of all the money we directed to the charities we recommend—the impact of our donors is impressive. We estimate these grants will:

• Save more than 24,000 lives
• Treat over 6 million children with a full course of antimalarial medication
• Provide vitamin A supplementation to over 8.6 million children
• Deliver over 4.4 million long-lasting insecticide-treated nets (LLINs) to protect against malaria
• Vaccinate 118,000 children
• Treat over 11.4 million children for parasitic worms

Read More

The post Our recommendations for giving in 2021 appeared first on The GiveWell Blog.

You can have a remarkable impact by supporting cost-effective, evidence-based charities.

Just looking at the approximately $100 million GiveWell had discretion to grant in 2020—a subset of all the money we directed to the charities we recommend—the impact of our donors is impressive. We estimate these grants will:

• Save more than 24,000 lives
• Treat over 6 million children with a full course of antimalarial medication
• Provide vitamin A supplementation to over 8.6 million children
• Deliver over 4.4 million long-lasting insecticide-treated nets (LLINs) to protect against malaria
• Vaccinate 118,000 children
• Treat over 11.4 million children for parasitic worms

Read More

The post Our recommendations for giving in 2021 appeared first on The GiveWell Blog.

A little over a decade ago in 2010, GiveWell directed around $1.5 million to the charities we recommended. In 2021, we expect we’ll raise at least $500 million, and may raise as much as $560 million or more.

We never anticipated that we’d grow this large this quickly. We’ve seen rapid growth from donors of all sizes, the most recent of which is a commitment of $300 million from Open Philanthropy.

While this growth comes with challenges—we’re working hard to hire enough researchers—it’s a testament to our donors' trust in us and enthusiasm for our mission.

But these big numbers are relatively small in the long-term scope of what GiveWell hopes to achieve. We believe there are billions of dollars' worth of annual cost-effective giving opportunities that we have yet to identify.

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The post We aim to cost-effectively direct around $1 billion annually by 2025 appeared first on The GiveWell Blog.

A little over a decade ago in 2010, GiveWell directed around $1.5 million to the charities we recommended. In 2021, we expect we’ll raise at least $500 million, and may raise as much as $560 million or more.

We never anticipated that we’d grow this large this quickly. We’ve seen rapid growth from donors of all sizes, the most recent of which is a commitment of $300 million from Open Philanthropy.

While this growth comes with challenges—we’re working hard to hire enough researchers—it’s a testament to our donors' trust in us and enthusiasm for our mission.

But these big numbers are relatively small in the long-term scope of what GiveWell hopes to achieve. We believe there are billions of dollars' worth of annual cost-effective giving opportunities that we have yet to identify.

Read More

The post We aim to cost-effectively direct around $1 billion annually by 2025 appeared first on The GiveWell Blog.

We believe malnutrition is a very promising area for charitable funding in the future. In 2021, we directed nearly $30 million to two organizations—The Alliance for International Medical Action (ALIMA) and International Rescue Committee (IRC)—working on malnutrition, and we expect to direct more funding to malnutrition programs in the future. (We have published a write-up about one of these grants here and will publish write-ups about the other grants in the near future.) To give a sense of what we expect, we would not be surprised if GiveWell directs as much funding to malnutrition in the future as we have to malaria programs in recent years.

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The post Why malnutrition treatment is one of our top research priorities appeared first on The GiveWell Blog.

We believe malnutrition is a very promising area for charitable funding in the future. In 2021, we directed nearly $30 million to two organizations—The Alliance for International Medical Action (ALIMA) and International Rescue Committee (IRC)—working on malnutrition, and we expect to direct more funding to malnutrition programs in the future. (We have published a write-up about one of these grants here and will publish write-ups about the other grants in the near future.) To give a sense of what we expect, we would not be surprised if GiveWell directs as much funding to malnutrition in the future as we have to malaria programs in recent years.

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The post Why malnutrition treatment is one of our top research priorities appeared first on The GiveWell Blog.

2020 was another year of tremendous growth. GiveWell donors contributed over $240 million to our recommended charities (our “2020 money moved”), a 60% increase from the approximately $150 million we directed in 2019. This is part of an exciting, long-term trend. Just a decade ago, in 2010, GiveWell’s total money moved was $1.5 million.[1]

We believe these donations will save tens of thousands of lives and benefit many others. This incredible impact would not be possible without the continued support and generosity of our donors. While our research enables us to identify and recommend highly cost-effective giving opportunities, our donors are responsible for turning those recommendations into real change for some of the poorest individuals in the world.

This post lays out highlights from our final 2020 money moved report and shares more details about how donors gave to GiveWell’s recommended charities in 2020.[2]

Summary of influence: In 2020, GiveWell influenced charitable giving in several ways. The following table summarizes our understanding of this influence.

Headline money moved: In 2020, we confidently tracked $244 million in money moved to our recommended charities, and via our GiveWell Incubation Grants program. This amount, which we call “headline money moved,” only counts donations that we are confident were influenced by our recommendations. This includes the grants we make through the Maximum Impact Fund. See Appendix 1 of our 2020 metrics report for additional details on how we calculate our money moved.

We also estimate that we are responsible for an additional $3 million in donations, but we are unable to attribute these donations directly to GiveWell. Because we are more uncertain about this influence, we do not include this amount in our “headline money moved” figure but include it in our “best guess of total money directed to charities” figure. [3]

The chart below shows the breakdown of our headline money moved into the following categories: grants that Open Philanthropy made to our recommended charities, donations from other donors to our recommended charities, and Incubation Grants. Please note that Open Philanthropy support (marked in gray) does not include funding it provided for GiveWell Incubation Grants, which are shown separately in purple. [4]

Money moved by charity (excluding Incubation Grants): Our nine top charities received the majority of our money moved. Our nine standout charities received a total of $2.2 million. Note that as of October 2021, we have discontinued the standout charity designation. [5]

Money moved by program (excluding Incubation Grants): Our recommended charities implement a variety of health and poverty alleviation programs. But some charities work on the same type of program. For example, we recommend four charities for their programs that support treatments for parasitic worm infections (deworming programs), and two charities for their programs to prevent malaria (Malaria Consortium’s seasonal malaria chemoprevention program and the Against Malaria Foundation). Here, we look at the breakdown of money moved by program type.

The majority of our money moved, including donations to our Maximum Impact Fund, was directed to malaria prevention programs—followed by unconditional cash transfers, conditional cash transfers to promote vaccination, deworming, and vitamin A supplementation. Other programs each received less than 1% of our total money moved.

Money moved by size of donor: We also analyze our money moved by the amount that different donors give, which we categorize into six different “size buckets” (see the chart below, which excludes funding from Open Philanthropy).

A caveat: Our analysis of money moved by donor size is incomplete because for approximately 39% of donations (excluding Open Philanthropy), we do not have data disaggregated by individual donor. Among the donations we can attribute to individual donors, the amount of money given increased across all donor size categories compared to 2019. Details are available in the full report.

Donations supporting GiveWell’s operations: GiveWell raised $43.6 million in unrestricted funding in 2020, compared to $19 million in 2019. Donors who gave over $100,000, including Open Philanthropy, contributed around 84% of GiveWell’s unrestricted funding in 2020. GiveWell’s total operating expenses in 2020 were $8.5 million.

We have only retained a portion of our unrestricted 2020 revenue for operating costs, and will be reallocating the remainder to discretionary grantmaking. [6]

For more detail, see our full metrics report (PDF).

References

Footnotes for this post may be found here.

The post GiveWell’s money moved in 2020 appeared first on The GiveWell Blog.

2020 was another year of tremendous growth. GiveWell donors contributed over $240 million to our recommended charities (our "2020 money moved"), a 60% increase from the approximately $150 million we directed in 2019. This is part of an exciting, long-term trend. Just a decade ago, in 2010, GiveWell’s total money moved was $1.5 million.

We believe these donations will save tens of thousands of lives and benefit many others. This incredible impact would not be possible without the continued support and generosity of our donors. While our research enables us to identify and recommend highly cost-effective giving opportunities, our donors are responsible for turning those recommendations into real change for some of the poorest individuals in the world.

Read More

The post GiveWell’s money moved in 2020 appeared first on The GiveWell Blog.

2020 was another year of tremendous growth. GiveWell donors contributed over $240 million to our recommended charities (our “2020 money moved”), a 60% increase from the approximately $150 million we directed in 2019. This is part of an exciting, long-term trend. Just a decade ago, in 2010, GiveWell’s total money moved was $1.5 million.[1]

We believe these donations will save tens of thousands of lives and benefit many others. This incredible impact would not be possible without the continued support and generosity of our donors. While our research enables us to identify and recommend highly cost-effective giving opportunities, our donors are responsible for turning those recommendations into real change for some of the poorest individuals in the world.

This post lays out highlights from our final 2020 money moved report and shares more details about how donors gave to GiveWell’s recommended charities in 2020.[2]

Summary of influence: In 2020, GiveWell influenced charitable giving in several ways. The following table summarizes our understanding of this influence.

Headline money moved: In 2020, we confidently tracked $244 million in money moved to our recommended charities, and via our GiveWell Incubation Grants program. This amount, which we call “headline money moved,” only counts donations that we are confident were influenced by our recommendations. This includes the grants we make through the Maximum Impact Fund. See Appendix 1 of our 2020 metrics report for additional details on how we calculate our money moved.

We also estimate that we are responsible for an additional $3 million in donations, but we are unable to attribute these donations directly to GiveWell. Because we are more uncertain about this influence, we do not include this amount in our “headline money moved” figure but include it in our “best guess of total money directed to charities” figure. [3]

The chart below shows the breakdown of our headline money moved into the following categories: grants that Open Philanthropy made to our recommended charities, donations from other donors to our recommended charities, and Incubation Grants. Please note that Open Philanthropy support (marked in gray) does not include funding it provided for GiveWell Incubation Grants, which are shown separately in purple. [4]

Money moved by charity (excluding Incubation Grants): Our nine top charities received the majority of our money moved. Our nine standout charities received a total of $2.2 million. Note that as of October 2021, we have discontinued the standout charity designation. [5]

Money moved by program (excluding Incubation Grants): Our recommended charities implement a variety of health and poverty alleviation programs. But some charities work on the same type of program. For example, we recommend four charities for their programs that support treatments for parasitic worm infections (deworming programs), and two charities for their programs to prevent malaria (Malaria Consortium’s seasonal malaria chemoprevention program and the Against Malaria Foundation). Here, we look at the breakdown of money moved by program type.

The majority of our money moved, including donations to our Maximum Impact Fund, was directed to malaria prevention programs—followed by unconditional cash transfers, conditional cash transfers to promote vaccination, deworming, and vitamin A supplementation. Other programs each received less than 1% of our total money moved.

Money moved by size of donor: We also analyze our money moved by the amount that different donors give, which we categorize into six different “size buckets” (see the chart below, which excludes funding from Open Philanthropy).

A caveat: Our analysis of money moved by donor size is incomplete because for approximately 39% of donations (excluding Open Philanthropy), we do not have data disaggregated by individual donor. Among the donations we can attribute to individual donors, the amount of money given increased across all donor size categories compared to 2019. Details are available in the full report.

Donations supporting GiveWell’s operations: GiveWell raised $43.6 million in unrestricted funding in 2020, compared to $19 million in 2019. Donors who gave over $100,000, including Open Philanthropy, contributed around 84% of GiveWell’s unrestricted funding in 2020. GiveWell’s total operating expenses in 2020 were $8.5 million.

We have only retained a portion of our unrestricted 2020 revenue for operating costs, and will be reallocating the remainder to discretionary grantmaking. [6]

For more detail, see our full metrics report (PDF).

References

Footnotes for this post may be found here.

The post GiveWell’s money moved in 2020 appeared first on The GiveWell Blog.

The World Health Organization (WHO) recently recommended the widespread use of the malaria vaccine RTS,S/AS011We’ll use “RTS,S” as shorthand in this post. jQuery('#footnote_plugin_tooltip_13408_1_1').tooltip({ tip: '#footnote_plugin_tooltip_text_13408_1_1', tipClass: 'footnote_tooltip', effect: 'fade', predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: 'top right', relative: true, offset: [10, 10], }); for children. It provides an additional, effective tool to fight malaria. This is great news!

We’ve been following this vaccine’s development for years and, in the last few months, have been speaking with organizations involved in its development and potential wider rollout.

Our work on RTS,S (and other malaria vaccines) is ongoing, and we might significantly update our views in the near future. But because we’ve been following its progress, we’re sharing some initial thoughts.

In brief

• This vaccine is a promising addition to the set of tools available to fight malaria, but it’s not a panacea. We expect long-lasting insecticide-treated nets (LLINs) and seasonal malaria chemoprevention (SMC)—interventions provided through two of the programs we currently recommend—to continue to be important in the fight against malaria in the near term.2
  • The parts of the WHO news release that we have bolded indicate that RTS,S should be used with existing malaria control interventions:
    • “WHO Director-General Dr Tedros Adhanom Ghebreyesus [said,] ‘Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.'”
    • “WHO recommends that in the context of comprehensive malaria control the RTS,S/AS01 malaria vaccine be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by WHO.”
  • Similarly, Gavi’s news release states: “The vaccine will be a complementary malaria control tool to be added to the core package of WHO-recommended measures for malaria prevention. This includes the routine use of insecticide-treated bed nets, indoor spraying with insecticides, malaria chemoprevention strategies, and the timely use of malaria testing and treatment.”
  
  jQuery('#footnote_plugin_tooltip_13408_1_2').tooltip({ tip: '#footnote_plugin_tooltip_text_13408_1_2', tipClass: 'footnote_tooltip', effect: 'fade', predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: 'top right', relative: true, offset: [10, 10], });
• Simple comparisons of potential costs and effectiveness of RTS,S and SMC suggest that SMC could be more cost-effective (see below). But there are lots of unknowns about RTS,S that could change that.
• We are actively looking into whether there are promising funding opportunities in this space.
• So:
  • For the time being, this news does not affect our recommendations to donors. We do not know of a current option for individuals to donate to scale up RTS,S. We continue to believe that LLIN distribution and SMC are highly cost-effective, and some of the best giving opportunities available for donors who want to prevent deaths from malaria today.
  • We aren’t sure whether we’ll recommend funding of RTS,S in the future. That will depend on how cost-effective we estimate particular opportunities to be, which depends on the answers to the open questions listed below.

Simple estimates of cost and effectiveness

• Cost.​​ SMC costs about $7 per child fully covered per year,3This is the average estimated cost per child in the four countries where we currently recommend funding for SMC. See here in the current version of our cost-effectiveness analysis. jQuery('#footnote_plugin_tooltip_13408_1_3').tooltip({ tip: '#footnote_plugin_tooltip_text_13408_1_3', tipClass: 'footnote_tooltip', effect: 'fade', predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: 'top right', relative: true, offset: [10, 10], }); so it would cost $28 to cover a child for four years. Costs for RTS,S are far less certain. Two studies that seem like reasonable starting points suggest costs per child of between $304See Sauboin et al. 2019, Table 2. The average cost across five countries for administering doses to children is ~$30. jQuery('#footnote_plugin_tooltip_13408_1_4').tooltip({ tip: '#footnote_plugin_tooltip_text_13408_1_4', tipClass: 'footnote_tooltip', effect: 'fade', predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: 'top right', relative: true, offset: [10, 10], }); and $40.5See Winskill et al. 2017, Table 1, row “RTS,S.” jQuery('#footnote_plugin_tooltip_13408_1_5').tooltip({ tip: '#footnote_plugin_tooltip_text_13408_1_5', tipClass: 'footnote_tooltip', effect: 'fade', predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: 'top right', relative: true, offset: [10, 10], });
• Effectiveness. Our rough estimate is that RTS,S would avert 36%6“Children were followed up for a median of 48 months (IQR 39–50) and young infants for 38 months (34–41) after dose 1. From month 0 until study end, compared with 9585 episodes of clinical malaria that met the primary case definition in children in the C3C [control] group, 6616 episodes occurred in the R3R [4 doses of RTS,S/AS01] group (VE 36·3%, 95% CI 31·8–40·5)…” RTS,S Clinical Trials Partnership 2015, “Findings” section jQuery('#footnote_plugin_tooltip_13408_1_6').tooltip({ tip: '#footnote_plugin_tooltip_text_13408_1_6', tipClass: 'footnote_tooltip', effect: 'fade', predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: 'top right', relative: true, offset: [10, 10], }); of malaria cases over four years.7We use four years because that’s the time period used in the trials (see the quote in footnote 6 above), and it presents an easy comparison with SMC and other child health programs we support that have annual costs. jQuery('#footnote_plugin_tooltip_13408_1_7').tooltip({ tip: '#footnote_plugin_tooltip_text_13408_1_7', tipClass: 'footnote_tooltip', effect: 'fade', predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: 'top right', relative: true, offset: [10, 10], }); By way of comparison, we estimate that annual SMC would avert 53% of cases over the same time period.8In particular, we assume SMC averts 75% of cases during peak transmission season and that 70% of malaria deaths occur during this period. Because we also assume a 1:1 ratio between cases and deaths averted, this is equivalent to averting ~53% of cases in a year. jQuery('#footnote_plugin_tooltip_13408_1_8').tooltip({ tip: '#footnote_plugin_tooltip_text_13408_1_8', tipClass: 'footnote_tooltip', effect: 'fade', predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: 'top right', relative: true, offset: [10, 10], });

Taken at face value, these figures could imply that SMC is 1.5 to 2 times more cost-effective than RTS,S. But these naive comparisons aren’t conclusive.9These comparisons are not equivalent to our full cost-effectiveness analyses (CEAs). In complete CEAs, we use country-specific figures instead of averages, try to adjust for internal and external validity, and try to account for the counterfactual funding decisions of all contributors and the value of their funds (which we call leverage and funging adjustments). These adjustments can make decision-relevant differences to our funding recommendations. jQuery('#footnote_plugin_tooltip_13408_1_9').tooltip({ tip: '#footnote_plugin_tooltip_text_13408_1_9', tipClass: 'footnote_tooltip', effect: 'fade', predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: 'top right', relative: true, offset: [10, 10], });

Open questions

There are many open questions whose answers could have a big impact on the cost-effectiveness of a particular opportunity to support RTS,S. Some questions that seem important to us are:

• What will it cost to deliver RTS,S? The cost estimates we’ve seen vary widely, and we expect delivery costs to vary from country to country.
• Will RTS,S be delivered via routine immunization systems or targeted immediately before seasonal malaria transmission? Routine immunization systems might be less costly, but seasonal delivery could increase effectiveness.
• How will RTS,S be layered with other malaria interventions in new implementation areas? We haven’t thoroughly investigated how the presence of LLINs and SMC in addition to RTS,S affect its efficacy in trial contexts, and we’re unsure how layering would affect the cost-effectiveness of delivering RTS,S in new areas.

In conclusion

We’re excited to have another effective tool in the fight against malaria! We’re working to understand whether there are cost-effective opportunities to support wider-scale implementation of RTS,S. Our research team is also keeping an eye on other potential malaria vaccines and malaria control strategies more generally. In the meantime, we anticipate continuing to recommend funding for LLINs and SMC.

Notes[+]

Notes ↑1 We’ll use “RTS,S” as shorthand in this post. ↑2

• The parts of the WHO news release that we have bolded indicate that RTS,S should be used with existing malaria control interventions:
  • “WHO Director-General Dr Tedros Adhanom Ghebreyesus [said,] ‘Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.'”
  • “WHO recommends that in the context of comprehensive malaria control the RTS,S/AS01 malaria vaccine be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by WHO.”
• Similarly, Gavi’s news release states: “The vaccine will be a complementary malaria control tool to be added to the core package of WHO-recommended measures for malaria prevention. This includes the routine use of insecticide-treated bed nets, indoor spraying with insecticides, malaria chemoprevention strategies, and the timely use of malaria testing and treatment.”

↑3 This is the average estimated cost per child in the four countries where we currently recommend funding for SMC. See here in the current version of our cost-effectiveness analysis. ↑4 See Sauboin et al. 2019, Table 2. The average cost across five countries for administering doses to children is ~$30. ↑5 See Winskill et al. 2017, Table 1, row “RTS,S.” ↑6 “Children were followed up for a median of 48 months (IQR 39–50) and young infants for 38 months (34–41) after dose 1. From month 0 until study end, compared with 9585 episodes of clinical malaria that met the primary case definition in children in the C3C [control] group, 6616 episodes occurred in the R3R [4 doses of RTS,S/AS01] group (VE 36·3%, 95% CI 31·8–40·5)…” RTS,S Clinical Trials Partnership 2015, “Findings” section ↑7 We use four years because that’s the time period used in the trials (see the quote in footnote 6 above), and it presents an easy comparison with SMC and other child health programs we support that have annual costs. ↑8 In particular, we assume SMC averts 75% of cases during peak transmission season and that 70% of malaria deaths occur during this period. Because we also assume a 1:1 ratio between cases and deaths averted, this is equivalent to averting ~53% of cases in a year. ↑9 These comparisons are not equivalent to our full cost-effectiveness analyses (CEAs). In complete CEAs, we use country-specific figures instead of averages, try to adjust for internal and external validity, and try to account for the counterfactual funding decisions of all contributors and the value of their funds (which we call leverage and funging adjustments). These adjustments can make decision-relevant differences to our funding recommendations. function footnote_expand_reference_container_13408_1() { jQuery('#footnote_references_container_13408_1').show(); jQuery('#footnote_reference_container_collapse_button_13408_1').text('−'); } function footnote_collapse_reference_container_13408_1() { jQuery('#footnote_references_container_13408_1').hide(); jQuery('#footnote_reference_container_collapse_button_13408_1').text('+'); } function footnote_expand_collapse_reference_container_13408_1() { if (jQuery('#footnote_references_container_13408_1').is(':hidden')) { footnote_expand_reference_container_13408_1(); } else { footnote_collapse_reference_container_13408_1(); } } function footnote_moveToReference_13408_1(p_str_TargetID) { footnote_expand_reference_container_13408_1(); var l_obj_Target = jQuery('#' + p_str_TargetID); if (l_obj_Target.length) { jQuery( 'html, body' ).delay( 0 ); jQuery('html, body').animate({ scrollTop: l_obj_Target.offset().top - window.innerHeight * 0.2 }, 380); } } function footnote_moveToAnchor_13408_1(p_str_TargetID) { footnote_expand_reference_container_13408_1(); var l_obj_Target = jQuery('#' + p_str_TargetID); if (l_obj_Target.length) { jQuery( 'html, body' ).delay( 0 ); jQuery('html, body').animate({ scrollTop: l_obj_Target.offset().top - window.innerHeight * 0.2 }, 380); } }

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