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Larissa Hesketh-Rowe

Why should I give if the rich don't?

 — particularly internationally! At the same time, 896 million live on less than USD 1.90 per day and 3 million children die each year 

What can we possibly do about these issues? And, quite frankly, why should we do anything at all if others do not?

Do the actions of others change what we should do? What can we achieve if we are not millionaires?

According to the World Bank’s most recent estimates in 2012, 

896 million people lived on less than $1.90 a day

over 2.1 billion people in the developing world lived on less than US $3.10

 go to international charities each year.

What is more, it is the poorest in America that give the highest percentage of their income to charity. Research by the Chronicle of Philanthropy in 2011 showed that the wealthiest Americans—those with earnings in the top 20% in America—donated, on average, around 1.3% of their income to charity. 

Americans in the bottom 20% donated about 3.2% of their income

. Not only that but the rich were much more likely to donate to institutions in their circle: universities they attended or the arts, rather than charities that help the poor.

If the rich are not doing their part, why should we try and help the global poor?

It’s tempting to argue that since there are so many people out there with the money to 

, they should be the first to pick up this responsibility. They can afford it. They are rich!

. This places the average person in these countries in the 

. This means that, even accounting for the different costs of buying goods in different countries, 

we likely earn about 18 times the global average wage

Where do you fall against the global average? See for yourself with the Giving What We Can 

We are extremely fortunate in many developed countries. Not only do we have great education, health and other services, but we have a lot of financial freedom too. And we can use that wealth to do amazing things.

Still, unless you are Bill Gates, it is likely that there are a lot of people out there who are richer than us. So why should we be the ones to give?

, imagine yourself walking past a pond on the way to work. As you walk, you spot two children struggling in the water. They are drowning. They need help. You are not a very good swimmer but you could at least save one in time. You about to jump in to save them when you realise there is someone else by the pond. They are nearer the children and look to be stronger, perhaps a better swimmer. They might be able to help both children. But they are doing nothing. Would you now do nothing? Just because someone else who might be better equipped to help more people is not? Would you leave the one child you could have saved to die because someone else won’t help both?

When we are wondering about issues around wealth and responsibility we can ask ourselves, 

what kind of world do we want to live in? One where many people are leaping to help or only a select few?

If we want change we have to be willing to lead it.

The drowning child example may seem far removed from the large-scale issue of global poverty, with 

896 million people on less than $1.90 a day

. The problem may seem just too big for any one person to do anything impactful.

In 1990, 1.95 billion people lived on less than $1.90 a day - now it’s 896 million. That’s 

Mortality rates for malaria fell 60% globally between 2000 and 2005.

The amount of money we need to end extreme poverty isn’t endless. While we may need $28 billion to give everyone basic sanitation education and health care, 

we spend $58 billion globally on ice cream each year

Imagine what we could achieve if we all got together to direct our funds with intention.

There may be 214 million people with malaria. But they are all individual men, women and children and as others walk by we can stop and help.

$5 would provide an anti malarial bednet that would help protect from the malarial bite of a mosquito for up to 5 years. 

 would allow the Schistosomiasis Control Initiative to give someone a tablet to get rid of intestinal worms which 

You don't need to live somewhere like this to make a big difference.

If you are on that UK average income of around £27000 and you decide to give 10% of your income you could fund over 500 anti malarial bednets in a year. Or over 2500 deworming tablets.

In a year you could donate enough to prevent someone from dying from malaria. Not the ‘treat one person on one occasion for one potentially fatal illness’ that many charities cite but really help ensure someone lives out a healthy life.

Even if you cannot give that much in a year, what you donate will still make a difference - as long as you donate to effective charities.

The drowning child analogy can sometimes seem far removed from reality because if we save a child from a pond we know we will save them. When giving to charity it’s harder to see the exact outcome and you may worry (sometimes rightly) that your money won’t really get to those who need it.

That’s why it is so important to try and work out the impact of our donations and look into 

 like the Against Malaria Foundation we can make sure the money we give goes as far as possible.

So why should we give even if the rich don’t?

In so much of the developed world we are incredibly fortunate in much of the financial freedom, opportunities and support we receive. Whilst we may not always feel it when compared to our close peers, 

Whatever our income, we can make a huge difference to someone by donating effectively. And when we all get together that change can be immense. At the time of writing Giving What We Can members have already donated $14,888,624 to effective charities! Imagine what we could achieve if more people gave.

If you’d like to find out more about what you can achieve why not 

? Set the amount and length of time and see what you can give.

Rob Tinworth

The Life Equation

Imagine yourself living in Guatamala with Crecencia, mother of seven, and her wonderful family. You're invited into her community, to break bread with them, to take part in their traditions and rituals. But Crecencia has late stage cervical cancer. She needs treatment that costs thousands of dollars. Money that could be used to pay for pap smears that will prevent hundreds of women from getting the disease in the first place. What do you do?

The is the story of Emmy-winning documentary filmmaker Rob Tinworth. Nine years ago, Rob married a physician and became interested in global health. He produced a series of short films that explored stigma in leprosy villages in China, maternal healthcare in a remote corner of Nepal, and child malnutrition in Guatemala. Everything he learned began to develop into 

https://player.vimeo.com/video/158336504?color=ffffff&title=0&byline=0&portrait=0"|embed("16by9","The

 he puts you in the driving seat. What information do you need to make a decision? Who are the people behind the statistics in global health? And how can we help them?

 to a hospital in Nepal where you must decide how best to save the lives of so many young mothers that die in child birth. See how the number of people dying of different diseases doesn't give us the whole picture.

Ask yourself what you would do if you were faced with the dilemma on whether to help Crecencia or prevent dozens of women from developing cervical cancer.

Rob is invited into Crecencia's life and he brings the audience along with him so that we can experience his turmoil and dive deep into not just the data but these people's lives.

Here's an excerpt from Rob bringing Crecencia's world to life:

"In a clearing in the dense jungle of Guatemala, the cameraman and I film a Mayan ceremony in the ruins of the ancient Kaqchickel capital of Iximché. It’s an emotional swirl of chanting, smoke, and fire – a ritual of healing for Crecencia, who is fighting cervical cancer. As we’re considering stepping back to capture a wide shot of the proceedings, the daykeeper, a kind of Mayan shaman, turns to me and says, “In one minute, it will rain. You should cover your camera”. When a shaman tells you to cover up your kit, you cover up your kit. Sure enough, just as we finish pulling a tarp over our camera the heavens open, and rain starts bucketing down in sheets.

The daykeeper pulls a tarp over Crecencia and the fire, but the rain has come on so rapidly that the fire has gone out. Crecencia leans down and blows into the fading embers. The fire explodes back into life, and as the symbolism of this action sinks in, I curse my ill-preparedness and set off back to the jeep to retrieve the wet weather cover for the camera.

As I pick out the trail with my headlamp, I stumble upon an altar, the candle-wax remains of another ceremony melted across it. I pause, alone with my thoughts. I’ve been so focused on capturing the scene that this is the first time I’ve reflected on the intensity of what I’ve been covering. It hits me in an instant, and I’m surprised to find myself sobbing uncontrollably.

Crecencia is going to need a lot more than prayer to treat her cancer. An American-backed NGO is fronting up the cash for radiation therapy in the hope of buying her a few extra years. On paper, I thought this was a crazy idea - $10,000 goes a long way in Guatemala, and that money could be spent on other programmes instead: child malnutrition, diabetes, or pap smears – that money could prevent hundreds of women from developing cervical cancer in the first place!

But standing in the clearing in the torrential rain, after days of filming Crecencia and her family, I don’t care how many wheelbarrows of cash it takes. Of course Crecencia’s treatment should be financed.

Weeks later, dry and ensconced back in my edit suite in Boston, I come across Toby Ord and ‘Effective Altruism’. At websites like this one, I read about the central premise - that we should use data and mathematical formulas to analyse healthcare interventions, and then fund the most cost-effective. I’m reviewing chart after chart showing that some treatments can save thousands of times more lives than others.

It’s a compelling argument, and I’m sucked right in. Medicine should be cost-effective. Not only to improve healthcare in poverty-stricken corners of the world, but also to rein in spiraling health care costs where I’m living, here in the US.

But following this logic, it’s ethically unsound to spend large sums on cases with poor outlooks. It’s ethically unsound to fund Crecencia’s treatment.

I’m stuck with no good answers, convinced that everyone has a right to the best medicine can offer, and equally convinced that health care should be driven by data to maximise its impact.

The Life Equation is an attempt to come to grips with that struggle, to explore the two sides of the debate, to understand why I feel so strongly that they’re both right, and to find a way to somehow resolve that.

I want to go beyond the scathing rejection of health care rationing as ‘medicine by death panels’ and beyond the realpolitik dismissal of ‘idealistic, unrealistic’ doctors.

I want to transport the audience into that forest in that rain with the chants of the Mayan daykeeper drifting through the trees. I want to put a human story on the faceless data and see what happens...

How did you feel following Rob down the rabbit hole? What would you decide to do with the money this NGO has raised? What about the people we've not met, such as those that could benefit from pap smears to prevent cervical cancer?

When we're striving to do the most good it is important to remember all of the individuals that make up the statistics. These decisions are hard. But big data and effective altruism are tools that can help us make them, and documentaries like this are powerful reminders of why it is so important. We can't ignore these choices, we're making them 

. Every time you decide to donate to one charity you also decide not to give to another.

So please, if you do one thing today, just take the time to think about Crecencia and this dilemma. 

 for yourself in the interactive documentary and let us know in the comments how you'd decide.

Ray Kennedy

Is there a more effective way of getting a (better) malaria vaccine?

World Malaria Day is next week! To celebrate the 

 made in the last decade towards eradicating malaria, join our 

We finally have a 35% effective malaria vaccine

. Last year, the world’s first malaria vaccine, Monsquirix/RTS,S, was recommended by European drugs regulators

 (though there are still some concerns about the safety of the vaccine

) and initial studies of cost-effectiveness have shown positive results, though it is slightly less cost-effective than insecticide treated bednets

. The vaccine has been developed under a product development partnership between the Bill and Melinda Gates Foundation and GSK. In exchange for funding support, GSK have made strong commitments to make the vaccine available at an affordable price

Discovering a new vaccine is excellent news. But we should still question our approach to vaccine development. Is the way we currently fund vaccine and drug research for developing countries working as well as it should? Are we missing out on opportunities? Can we make progress faster?

Because the speed at which we develop a vaccine matters.

Just speeding up the discovery of a vaccine by a single year and the adoption of this vaccine in poor countries by two years, could save many lives4. One analysis suggested that spending $3bn to achieve this would only cost $80 - $90 per additional life year saved

So when we think about developing a malaria vaccine 

we should remember that there are big payoffs if we can speed up the process.

One of the ways we can divide different funding efforts is between push and pull funding mechanisms.

 funding mechanisms pay for or subsidise 

 (like paying a team of researchers to do research). 

 or outcomes, for instance, by paying a prize for successfully developing a drug, or guaranteeing a future price at which a profit can be made

In the case of the malaria vaccine, the Gates Foundation pursued a ‘push’ funding approach.

A big downside with push-funding approaches is that they can dis-incentivise other organisations to develop vaccine candidates. In this case, anyone else developing a malaria vaccine would end up competing with a vaccine which will be sold at close to marginal cost

Regrettably the RTS,S vaccine offers only modest protection from malaria

: it is about 35% effective, meaning that Mosquirix reduces the number of cases of clinical malaria in children by about 35% over a two year period. This is very low when other highly effective vaccines for children such as 

But there are many of other malaria vaccine candidates being investigated

 - although they are probably receiving much less funding to do so

. So it is perfectly possible there are other more effective vaccines than RTS,S waiting to be developed - and putting money behind just one vaccine, may have slowed or stalled their progress. This is because there is another way of developing vaccines (and indeed other products): 

recreate the market incentives that help develop drugs in richer countries

. Donors make legally binding pledges to subsidise vaccines which meet certain requirements. But crucially they aren’t tied to any particular manufacturer. This means that donor organisations don’t have to pay if development is unsuccessful, and they don’t have the difficult decision of assessing which pharmaceutical company has the most promising vaccine prospect. This decision is instead left to pharma companies themselves- who are better placed to evaluate the prospect of success.

This approach was used to develop vaccines for pneumococcal diseases common in the developing world. A collection of governments alongside the Gates Foundation committed $1.5bn as a top-up subsidy for manufacturers if they agreed to develop and supply vaccines at a low price

How can we do better in the case of malaria?

Would this approach have worked better in the case of malaria? Would it have found a quicker solution?

Ultimately these are very difficult questions to answer. But these issues of skewed funding incentives were well known over a decade ago

There can be downsides to an AMC approach. Critics allege that the AMC could have negotiated a price closer to the cost of production and that other push funding efforts have had more success in negotiating a low price

. The fact that drug companies have voluntarily lowered the ‘tail price’

 under the AMC suggests it was set too high originally. Some see the AMC as overly generous to existing large developed country pharmaceutical companies

almost all the organisations and people involved in vaccine or drug development have strong incentives to prefer push funding

. Donors might prefer giving money to support local companies and research outfits. Activist organisations may strongly dislike the idea that private companies can make big profits from pull funding (although they can lose money from unsuccessful research efforts). Drug companies- and also academics- may prefer a guaranteed flow of money for research rather than it being tied to results.

We still have not seen another Advance Market Commitment comparable to that launched for pneumococcal vaccines that was first announced back in 2007. And there are many diseases other than malaria that could benefit from new efforts to develop vaccines or new drugs against them.

even while we celebrate a new tool against malaria, we should still stop to consider whether there is a better way to get to effective vaccines

Xin Ya Lim

How to improve women's health in poor countries

It has long been established that women face many health problems largely because of their roles in society 

. However, some of these health problems are also due to the lack of provision of health services irrespective of gender 

 and the lack of governmental commitment to address health problems 

 are two of the crucial factors that result in inadequate facilities and the lack of trained professionals in health services.

Everyday problems, like long waiting periods to see an obstetrician in emergency care, may seem like commonplace issues, but very often they are indirectly due to the poor management of the healthcare system 

. Health-related research could consider the broader picture by evaluating the role of authoritative figures in improving health care.

The focus on personal health problems that many women face in developing nations could be shifted on to policy makers.

the role of the government in addressing maternal mortality, female genital mutilation (FGM), and cervical cancer

Blog

Why should I give if the rich don't?

The Life Equation

Is there a more effective way of getting a (better) malaria vaccine?

How to improve women's health in poor countries

Can cancer interventions ever be cost-effective?

Four Ideas You Already Agree With (That Mean You're Probably on Board with Effective Altruism)

[Interview] Why Derek Thompson of The Atlantic took the Giving What We Can pledge

Why you should apply for the September Internship

Old Weapons and New: How We Can Win The Fight Against Malaria

What it's like to intern at Giving What We Can