GiveWell Conversations

Routine childhood immunizations, provided on a set schedule over a child’s first two years of life, are very effective at reducing some of the major causes of death in young children. We estimate that in the provinces where we’ve supported programs in the Democratic Republic of the Congo (DRC), about one in 13 unvaccinated children dies from vaccine-preventable diseases before the age of five, yet only about half of children there receive the vaccinations they need. Much of our Vaccination research subteam’s work focuses on finding ways to make it easier for caregivers to have their children vaccinated, such as bringing vaccines closer to where parents and infants live. This is especially important in places like DRC, where coverage is low and disease burden is high. Following a request for proposals and a request for information seeking targeted vaccination outreach programs, we funded 11 additional programs, run by distinct organizations—six of which will be implemented in DRC. This portfolio builds on years of investment in our research team, which allowed us to evaluate more than 100 proposals and fund several programs side by side to learn which approaches work best. In this episode, GiveWell co-founder and CEO Elie Hassenfeld speaks with Senior Program Officer Natalie Crispin, who leads GiveWell’s vaccination grantmaking, about the programs we funded in DRC. They discuss barriers preventing many children in DRC from getting vaccinated, how the programs we’re funding aim to reach them, and what we hope to learn.Elie and Natalie discuss:Identifying barriers to full vaccination in DRC: Based on the evidence we’ve reviewed, our past experience funding vaccination programs, and the experts we’ve consulted, we think reliable access to opportunities for children to be vaccinated is a major barrier to coverage. The typical immunization schedule requires eight or nine visits to a health facility over a child’s first 18 months. In DRC, families living within about three miles of a health facility are generally expected to travel there. This can mean walking several miles to the nearest health facility while carrying a small child, with no guarantee that the needed supplies or staff will be available to vaccinate their child when they arrive. Mobile vaccinators travel to reach families living further than three miles from a facility, but there are often insufficient resources to ensure these outreach sessions take place on the needed schedule and in the hardest-to-reach communities. Funding different strategies for reaching under-vaccinated children: Each of the six outreach programs we are funding in DRC includes two core components: (1) a method for identifying the communities that need additional support and (2) a strategy for reaching those communities, often by increasing how often vaccination teams travel from health facilities to underserved villages. In many of the programs, a small vaccination team travels by motorbike with a cooler of vaccines, sets up in a central spot that community health workers often announce in advance, and gives each child the vaccines they need. The details of the programs vary. For example, one organization is implementing an app that helps health teams log their work, allowing supervisors to track activity and make changes in an effort to increase coverage rates. Learning which approaches work best: In order to compare the cost-effectiveness of various approaches and organization types, we've chosen a diverse grant portfolio of programs and organizations (including large international NGOs, organizations focused on data and technology, and nonprofits with deep experience with the DRC health system). To assess the results, we’re funding independent coverage surveys before program implementation and every year afterward, using comparison groups wherever we can to assess whether changes in coverage were caused by the program. We’re also drawing on programs’ own monitoring data and talking with government officials, other funders, and implementers in the same areas. Over time, we plan to scale up those that increase coverage most cost-effectively to help people in need as much as we can. We expect efforts to increase coverage of routine childhood immunization to make up at least half of our vaccination grantmaking, as these vaccines have the greatest potential to save lives. The team is also assessing the cost-effectiveness of filling funding gaps for purchasing vaccines, starting with malaria vaccines, and researching other vaccines that aren’t fully funded. With a larger, more experienced team, we can now research vaccines in more depth and fund multiple vaccination outreach programs to assess which are most cost-effective. We’re bringing that approach to all of our work, so we can do the most good we can with donors’ funds.For more on how our vaccination grantmaking has evolved, see our earlier podcast episode with Natalie. Visit our All Grants Fund page to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.This episode was recorded on October 27, 2026, and represents our best understanding at that time.

In an effort to direct substantially more funding to the most cost-effective opportunities we can find to help people, GiveWell’s research is expanding in two directions at once: going broader, to cover more areas of global health and development, and going deeper, to improve the inputs that inform our decision-making.This episode offers a behind-the-scenes look at how this expansion is playing out on GiveWell’s research team, as three researchers each describe a project they have taken on: reassessing how to prevent childhood pneumonia deaths, building a better estimate of how many children die of malaria, and developing an AI tool to check our work for errors.In this episode, GiveWell co-founder and CEO Elie Hassenfeld speaks with Senior Program Officer Dilhan Perera, Senior Researcher James Watson, and Research Analyst Meghna Ray about the projects they’ve worked on and what it’s like to do research at GiveWell.Elie, Dilhan, James, and Meghna discuss:Changing direction as we follow the evidence: Pneumonia causes around 10% to 15% of deaths among children under five globally. Our New Areas research subteam, which investigates cause areas that are newer to GiveWell, first examined community-based treatment options for reducing these deaths by treating children with amoxicillin, an inexpensive antibiotic. That approach initially looked promising, but conversations with researchers and implementers indicated that many pneumonia deaths today are caused by infections that amoxicillin doesn’t treat. We then shifted our attention toward another strategy for reducing pneumonia deaths: providing medical oxygen for severely ill children in hospitals. This costs more per patient but targets the children at greatest risk of dying and can also treat diseases beyond pneumonia. If expanding access to medical oxygen proves cost-effective, it could become a new way for GiveWell to help prevent these deaths.Improving our estimates for key cost-effectiveness inputs: Assessing the cost-effectiveness of malaria programs generally requires estimating the number of children who die from malaria in a given place, but that figure is surprisingly uncertain. In many places where we fund programs, cause-of-death data come mainly from interviews with families rather than from health system records. Because malaria symptoms are very similar to symptoms for many other diseases, knowing the symptoms a child was experiencing is often insufficient to determine whether malaria was the cause of death. To more accurately determine the share of deaths caused by malaria, we are developing an approach based on the share of school-aged children infected with malaria (which can be measured accurately using rapid fingerprick tests) and the overall child death rate (measured reliably using large household surveys). We then use the relationship between infection levels and deaths to estimate how many are attributable to malaria. Because this approach is based on data that we think can more reliably assess malaria-specific deaths, we expect it will be better at identifying differences in malaria deaths between regions, which could allow us to target malaria funding to the places where it will do the most good. Developing new tools to increase research capacity: Our cost-effectiveness spreadsheets are often very complex, and errors in their formulas or inputs can meaningfully change our estimate of a program’s cost-effectiveness, which is a key factor in our funding decisions. Research analysts have long vetted these analyses line by line to ensure their accuracy. We recently built an AI tool to assist in that process. Early versions reliably caught errors in formulas but often missed issues a human reviewer would catch, such as outdated data or inconsistent assumptions. To address this, we compiled errors analysts had found in past reviews and refined the tool until it caught more than 90% of them. The tool now serves as a first pass, followed by a research analyst reviewing its findings. As a result, vetting that took as long as a week now takes a few hours. Speeding up this check while maintaining accuracy frees researchers to spend more time on the substantive questions behind our grants.This conversation explores aspects of our research process: building models, engaging with academic experts and implementing organizations, prioritizing the questions most likely to change our minds, and checking our work. This is part of what our researchers do, and we're actively hiring for research roles so that we can keep identifying highly cost-effective programs and directing donors’ funds to the programs we think will do the most good.Visit our All Grants Fund page to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.This episode was recorded on September 16, 2026, and represents our best understanding at that time.

GiveWell works to continually improve our research so we can make better grant decisions and direct donations where we believe they can do the most good. GiveWell’s Cross-Cutting research subteam is an important part of that effort—it investigates the impact of the programs we fund, works to resolve our largest uncertainties, and aims to improve our research. As GiveWell’s grantmaking grows, the Cross-Cutting subteam is strengthening our data collection and analysis to support that growth. In this episode, GiveWell co-founder and CEO Elie Hassenfeld speaks with Program Director Alex Cohen, who leads the Cross-Cutting subteam, about how better data can improve our decision-making, our work to gather stronger evidence, and the ways we’ve tested AI as a tool to increase our research capacity and quality.Elie and Alex discuss:Triangulating multiple data sources to check impact: Directing donations to programs we believe will do the most good requires understanding the impact of the programs we support. Organizations provide us with monitoring data, but we know there are many ways that, despite the best intentions, this data can be biased or incomplete. To address this, we are investing in additional sources and types of data to improve the accuracy of our estimates. For example, in Burkina Faso we’re funding dried-blood tests to better understand whether caregivers are completing the second and third at-home doses of seasonal malaria chemoprevention (SMC), which provides preventive malaria medication. We think this will improve our understanding of how accurate self-reported data is and whether funding to boost coverage of second and third doses of the medication could cost-effectively help people.Setting quality standards for survey data: GiveWell often collects survey data at the end of a program to better understand its impact and answer our open questions, but survey data is prone to error. For example, GiveWell researchers shadowed surveyors in Uganda and Nigeria who worked long days under time pressure, creating conditions where hard-to-access households were more likely to be skipped. Because those households may also be the ones programs are most likely to miss, this could lead to overestimating coverage. We’re working to reduce these errors by investing in more independent data checks, and we’ve developed survey guidelines that include practices like GPS tracking and verifying whether a random sample of households was surveyed.Using AI to critique our work: GiveWell is experimenting with AI tools to increase our research capacity and improve its quality. Our cost-effectiveness models are an important part of our funding decisions, and we carefully vet them to reduce the chance of mistakes. We’ve developed and trained an AI model that, with human oversight, can catch errors that previously required tedious staff review, opening up some capacity for those reviewers to support the team in other ways. We're also experimenting with using AI to critique and identify weaknesses in our research, though we’ve had more limited success with this strategy.  By investing in more and better data and experimenting with new tools, we’re working to expand our research capacity while strengthening the rigor of our work as our grantmaking scales. Growing our research team is central to these goals, and GiveWell is actively hiring researchers and program officers. New members of our research team typically start on the Cross-Cutting subteam as part of their onboarding and training. If someone you know might be a good fit, please share our open roles!Visit our All Grants Fund page to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.This episode was recorded on August 21, 2026, and represents our best understanding at that time.

GiveWell, with co-funding from Coefficient Giving, recently made our largest grant to date: $276 million to the Against Malaria Foundation (AMF) to support the procurement and distribution of 92 million nets in the Democratic Republic of the Congo (DRC) from 2027 through 2029. We estimate that the nets, 46 million of which we think would not otherwise be distributed, will avert roughly 67,000 deaths. We have supported AMF’s work for more than 15 years, and the insecticide-treated nets it procures and distributes remain one of the most cost-effective ways we've found to save lives. This grant, which involved a more rigorous investigation process than most, is part of a larger story about scaling our team and systems to handle substantially more funding while deepening our research rigor. Last year, we directed more than $400 million to highly cost-effective programs to save and improve lives and, this year, we expect our grantmaking to approach, and possibly exceed, $1 billion. This increase in grantmaking aims to meet global needs faster and more effectively.In this episode, GiveWell co-founder and CEO Elie Hassenfeld speaks with Senior Program Officer Alex Bowles about the questions the team set out to answer during the grant investigation.Elie and Alex discuss:Assessing the impact of insecticide-treated nets in DRC: GiveWell usually estimates a program’s cost-effectiveness and impact by analyzing academic evidence, particularly randomized trials, and making a number of adjustments. Because of our growing capacity, we were able to do something new for this grant: We tested our assumptions about DRC’s past net campaigns by drawing on two new, independent lines of evidence. First, we analyzed a recent national survey, which showed a reduction in malaria infections close to what we had predicted. Second, we commissioned a firm based in DRC to interview households and community leaders. Those interviews confirmed records about nets received and provided information about the challenges of conducting net campaigns in DRC. Taken together, this more robust approach increased our confidence that nets work well and are likely to reach intended households in the locations funded by this grant.Planning and coordinating at scale: This grant is nearly three times the size of our previous largest grant (also to AMF) and is concentrated in one country rather than being spread across several. The grant commits funds at the beginning of a multi-year planning cycle, which we think will make these campaigns easier to plan. It also aims to ensure that campaigns happen across all 26 of DRC’s provinces, in some cases on an expedited timeline. This shift in our funding approach makes close coordination with AMF and other partners—including the Global Fund, which is funding much of the net distribution, and the national malaria program—even more important than before.Rethinking how often nets are distributed: In most countries, nets are distributed every three years, but evidence shows that nets wear out more quickly in DRC, in part because of the climate. Our analysis of national survey data, net durability studies, and AMF’s post-distribution monitoring suggests that nets in DRC last roughly 18 to 24 months. DRC had already shortened its campaign cycle, aiming to distribute nets every 30 months. With the support of the government, GiveWell is supporting net campaigns every 24 months in several provinces with high rates of malaria transmission, and funding evidence gathering so we can learn whether more frequent net campaigns is a cost-effective strategy for further reducing malaria rates. We think this approach will help further prevent malaria and potentially save more lives.A larger, more experienced team enabled us to investigate this grant more deeply than we could have even two years ago—looking back at past grants to assess their estimated impact and asking important questions about the challenges of implementing such a large program. The same capacity that allowed us to research this grant, which we expect to save tens of thousands of lives, is also helping us look ahead to newer strategies that could save even more lives in the future.Visit our All Grants Fund and Top Charities Fund pages to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.This episode was recorded on August 14, 2026, and represents our best understanding at that time.

When GiveWell investigates a new cause area, we’re often focused on two priorities: directing funding where we think it can help people most and generating evidence to inform larger investments later. Family planning is a clear example. Recent foreign aid cuts—including reductions from the US, UK, and Dutch governments—deepened an already substantial need and opened up new cost-effective funding opportunities.When we published our last podcast episode on family planning, GiveWell had made only a couple of small grants. Since then, we’ve made a number of additional grants totaling around $20 million, exemplifying how our growing research capacity and expertise enable us to expand into new areas. By doing so, we aim to move more donor funding faster to global health programs where it can do extraordinary good.In this episode, GiveWell co-founder and CEO Elie Hassenfeld speaks with Senior Program Officer Dilhan Perera about the family planning programming we’ve funded over the past year, how we’ve structured our grant portfolio, and what we’re hoping to learn.Elie and Dilhan discuss:Funding across the family planning system: Providing people with family planning resources requires a three-tiered system: (1) purchasing contraceptives, (2) moving them through the supply chain to health facilities, and (3) delivering services to clients. We have made grants at all three levels. For example, we recommended a grant for contraceptive procurement through UNFPA Supplies, which works in dozens of countries, addressing a chronic shortfall that deepened after US government cuts. We also approved a one-year grant to MSI Reproductive Choices to help move supplies from national warehouses to local health facilities in the Democratic Republic of the Congo, Malawi, and Zambia. By funding across all three levels rather than at a single point, GiveWell aims to identify the areas of greatest need where additional funding could do the most good.Reaching people with limited access: Many people in low- and middle-income countries have limited access to modern contraception. GiveWell has made two grants aiming to increase access at the local level, each taking a different approach. The first supports MSI Reproductive Choices’ mobile outreach program, which we are funding in Nigeria and Sierra Leone. Small teams, typically two nurses and a driver, travel to communities identified as having limited access to services. The nurses offer a group information session and individual counseling, after which people who are interested can obtain a range of contraceptive methods, including long-acting options like implants and IUDs that health workers at nearby facilities often aren’t trained to administer. The second supports Lafiya, which operates in northern Nigeria, where modern contraceptive use is among the lowest in the world. Lafiya trains nurses, midwives, and community health workers who already live in these communities to provide family planning counselling, short-term contraceptives, and referrals for other methods. By funding both approaches, we hope to learn more about differing strategies for delivering family planning and the programs’ cost-effectiveness, potentially leading to opportunities to help people in need even more. Building evidence alongside the grants: There are relatively few randomized trials of family planning programs and limited rigorous evidence on the specific programs we’re funding. As a result, we have a number of uncertainties. We’re particularly interested in getting better answers to the following questions: Does providing family planning commodities actually increase use, or does it substitute for what people would’ve gotten another way? Do the commodities we help procure actually reach facilities? And to what extent are people making informed choices about whether or not they want to take up contraception? We’ve built learning opportunities into all of our family planning grants, including, for example, separately funding Innovations for Poverty Action to conduct independent surveys of clients and households in the areas where MSI’s mobile outreach program works. GiveWell’s research and grantmaking for family planning programs is still in its early stages, but it reflects a strategy across many of our newer grantmaking areas: directing donations to help people now, while generating the evidence needed to direct more funding to highly cost-effective programs in the future. Read more about how we're thinking about family planning mobile outreach, visit our All Grants Fund page to learn how you can support this work, and listen or subscribe to our podcast for our latest updates.This episode was recorded on July 22, 2026, and represents our best understanding at that time.