GiveWell drops four deworming programs: Are the worm wars back?

GiveWell, the impact-focused charity evaluator, has dropped four deworming programs — a poster child of affordable development interventions — from its list of top charities that “save or improve lives the most per dollar.” The organization that has built its reputation and significant financial clout by promising donors it will help them channel their money toward the most immediately impactful programs determined that deworming did not meet new criteria that also prioritizes a high likelihood of significant impact. Acknowledging that there is too much uncertainty about the potential outcomes, GiveWell moved the deworming programs — run by The END Fund, Evidence Action, SCI Foundation, and Sightsavers — off the list in August. Though the four programs and GiveDirectly — the other charity that was also taken off the list — might be eligible for GiveWell funds through a new portfolio, according to officials from the organizations, the decision is still likely to be a financial blow. This is particularly true for the deworming efforts, which GiveWell has channeled millions of dollars into over nearly a decade. “GiveWell has been a big driver of the considerable visibility that deworming as an intervention has had over the last 10 years,” Grace Hollister, the chief engagement officer at Evidence Action, told Devex. Evidence Action’s Deworm the World initiative first appeared on the top charity list in 2013. “I do expect donations to shift toward the top charities, even if they do still have a path for people to donate to interventions like deworming.” --— Eva Vivalt, economist and expert in evidence-based policymaking Global deworming efforts have weathered controversies in the past, including the “worm wars” — a largely online battle that questioned the research findings used to elevate deworming as a development priority. And GiveWell has emphasized that it was not influenced by that controversy. But observers said the decision to drop the deworming programs is certain to have financial implications and to potentially resurrect the battle. The rise of deworming campaigns GiveWell emerged in 2007 as an early leader in the movement to use evidence to figure out how to do the most good, known as effective altruism, or EA. It introduced a list of top charities the same year. The evaluator’s clout grew substantially after it began working with Good Ventures, whose co-founder, Dustin Moskovitz, is determined to give away the multibillion dollar fortune he made as a Facebook co-founder. GiveWell and Good Ventures partnered on Open Philanthropy in 2014. It is now an independent organization that directs most of its funds to charities that GiveWell recommends, particularly its top charities. That list has shifted over time, though deworming initiatives have been on it since 2013. Intestinal worms have long plagued communities in low- and middle-income countries, but mass deworming of schoolchildren reemerged as a prized intervention in the early 2000s, when results from a study in Kenya conducted in the late 1990s seemed to show mass deworming could improve school attendance and overall health, both for the students that received the medication, but even nearby kids who did not. That spurred global deworming campaigns and made the initiative an EA darling, since buying and administering the deworming drugs is relatively inexpensive at less than 50 cents per treatment. In return, advocates pointed to evidence that students who benefited from the initiative over two or three years had better wages and higher consumption expenditures than those that did not. Deworming has long been dogged, however, by questions of just how effective it is. Efforts to replicate and reanalyze the influential Kenya study published in 2015 found errors and missing data that seemed to undermine the findings, sparking the worm wars. Proponents of deworming hit back with their own critiques of the reanalysis of the Kenya study. “It’s one study in one region,” Dan Stein, the chief economist at IDinsight, told Devex. “It’s a lot of evidence coming from this very singular situation and it’s unclear how you can extrapolate from that.” Still, he considers deworming a good investment: “You’d be hard-pressed to find someone who says this is a total waste of money.” GiveWell certainly doesn’t think so. The evaluator does not appear to have been influenced by the years-old worm wars. It took pains to emphasize that it still “estimate[s] it to be highly cost-effective—deworming programs are very inexpensive, and we think there’s a small chance they may lead to large income gains later in life,” in its announcement of the top charities change. Still, the evaluator decided there was too much uncertainty about the impact of the intervention to keep it on the top charities list. Previously the company considered evidence of effectiveness, cost effectiveness, room for more funding, and transparency. To register as a top charity now, GiveWell must have previously donated significant money to the program and seen it used effectively and be convinced that the grant will make a direct impact and be cost effective. That means a program “must be estimated at 10 times as cost-effective as unconditional cash transfers.” GiveWell is also looking for evidence that there’s a high likelihood of significant impact, as opposed to a lower likelihood of enormous impact. And in the reevaluation, GiveWell was “more uncertain about deworming than we are about our current top charities,” leading the evaluator to conclude that deworming programs did not fulfill this criterion. A GiveWell spokesperson declined to comment for this story. Impact on funding The deworming programs had “ample notice,” the change was coming, Evidence Action’s Hollister said. It is unclear whether the deworming programs will maintain the same level of funding support from GiveWell, though some observers are skeptical. “I do expect donations to shift toward the top charities, even if they do still have a path for people to donate to interventions like deworming,” Eva Vivalt, an economist and expert in evidence-based policymaking, told Devex. Hollister is unsure of the funding implications for the Deworm the World initiative, though she said internal models have concluded it will have an impact. But if “GiveWell fills the funding gap, it shouldn’t result in any effective backsliding.” And there are indications the evaluator will do so through its All Grants Fund, which it uses to support high-risk programs that it believes are still cost-effective and capable of saving and improving lives. Then there is the nonfinancial impact. Though GiveWell has explicitly signaled there is no change in its perception of the importance of deworming, experts cautioned that casual GiveWell donors might still see the change in designation and overlook the explanation, leading to assumptions that deworming had somehow fallen in effectiveness. For more sophisticated donors, though, Stein said it was a long-overdue clarification of GiveWell’s thinking about deworming. “They were saying that their charities were the highest impact in the world, but highest impact is contingent on having a certain type of data and a certain type of certainty and there’s a little tension because of that,” Stein said.