Daniel

Couple thoughts: 1) After several people pointed out that Lyman couldn't substitute all-cause mortality for malaria-specific mortality like he had done, he fixed it. His initial estimate for $/lives saved was $19000; revised it’s about $8,200. 2) I think, though I could be wrong about this, that his calculation to get $8200 still has a problem: he calculates the costs of the distribution based on the whole population but the benefits based on 75% of the population (since he argues the other 25% is already sleeping under nets). But as he himself identifies, the nice thing about an intention-to-treat analysis is that you don't need to do this and shouldn't: you just ask how much to expect mortality to fall in a village after handing out the nets, and the answer is 17%. (You only care about the fact some people are already sleeping under nets if that makes your village unlike the one where the 17% was measured; more on that below.) If he changed this one factor this would make his numbers quite close to GiveWell's. 3) He then applies an adjustment for the long-term: "If bednets reduced short-run all-cause mortality by 18% in the 1990s and maybe reduce it by (who knows?) 14% today, they probably reduce actual child mortality (i.e. across 5 years of early childhood) by 7-11%." But GiveWell actually accounts for that even more stringently by just excluding all benefits past the first two years, one of several places where they are intentionally conservative. 4) He accuses GiveWell of misrepresenting Cochrane's statistics but they actually just report a bunch of different numbers and I think he mixed them up. He complains "GiveWell cites that review to support a “45% reduction in malaria incidence.” That’s an error, that review did not find a 45% reduction in malaria incidence." But the review absolutely does report almost exactly that: "Insecticide-treated nets also reduce the incidence of uncomplicated episodes of Plasmodium falciparum malaria by almost a half (rate ratio 0.55, 95% CI 0.48 to 0.64; 5 trials, 35,551 participants, high-certainty evidence". Rate ratio 0.55 means a 45% reduction. 5) He expresses concern that a lot of the Cochrane studies are old and describe a different environment (Africa in the late 1990s/early 2000s). However, GiveWell's most recent grant to nets in the DRC - which I believe that my donations helped to fund - is based on data from a 2023-2024 large scale demographic survey in the DRC, so the nets are being distributed in an environment very close to the one studied. It found about a 14% all-cause mortality reduction in the first year after a distribution, close to the 17% in Cochrane. He also expresses concern that Cochrane's mortality estimate here is low-powered but I don't think it is (the analysis says "rate ratio 0.83, 95% CI 0.77 to 0.89; 5 trials, 200,833 participants, high-certainty evidence") so it's between 11% and 23% with a 95% CI! 6) He also raises questions about whether there are more people trying to hand out nets than nets to be handed out. GiveWell looked into that and determined that in the DRC, there was not enough funding to do all the distributions that were indicated, in part because the Global Fund caps how much it'll spend in any one country. 7) Finally, he argues we should instead - from an altruistic perspective - spend our money however maximizes GDP. But I think there's a serious case that health interventions like combatting malaria are necessary for GDP growth to take off in DRC, just like the American South was kind of a backwater until we eradicated malaria there. Being constantly sick is horrible for productivity. Being only able to hire employees who are constantly sick is horrible for a business environment. GiveWell estimates that a $1,000,000 donation increases adult income for 80,000 children by 0.6%, which means that much of their modelled benefit of malaria nets *is* their GDP effects. My best guess is that if you were a hard-nosed GDP maxxer you'd invest a lot in reducing the disease burden in poor countries. Or maybe you'd go all in on making AI happen as fast as possible, something I rarely see EAs criticized for failing to do. I would probably donate more money to making AI go well if I had more of an idea of how to do that and it wouldn't create a bunch of conflicts of interest with my reporting work. I agree it would be cool if there were an organization focused on effective institutional capacity building in poor countries, but the reason I and man others don't donate to this is not that everyone fails to realize how important institutions are, it's that even though many people have worked very hard on the problem for a long time they do not have a way better than the nets to turn my money into GDP growth in poor countries. There was a bit of a Our World In Data article I read this fall that has stuck with me: "I’ve never had malaria, but I know several people who have. They describe it as one of the worst experiences of their life. What starts out feeling like the flu — which is bad enough — can quickly progress into something far worse. The body swings from intense fever and sweats to chills deep enough to make you shake uncontrollably. Everything aches, from your muscles and joints to the pounding headache that makes it impossible to think clearly. Your body is so fatigued that it’s a battle to make it to the bathroom when the nausea and vomiting arrive. That’s what a pretty standard infection feels like. For some, it goes much further. Here is how one account describes it: “I awoke to what felt like lightning going through my legs, and then spreading through my body and in my head. Probably the worst headache, body aches, and chills you could possibly imagine. It felt like I was being stung repeatedly by an electric shock gun and could barely control my movements. The pain was so intense; I actually believed I was dying, literally crying out in pain so bad that I was taken to a 24-hour clinic that night at 3am.” In Senegal, the median child experienced 43 attacks of malaria over the course of their childhood. My hard-nosed productivity obsessed persona says "I bet that's rough on their human capital development, and it's quite cheap to prevent." But mostly I don't, actually, say that to myself. I just buy some nets. If something even better comes along I'll do that, but I haven't seen it yet.