sreers's Quick takes

Summary Immediate skin-to-skin contact (SSC) between mothers and newborns and early initiation of breastfeeding (EIBF) may play a significant and underappreciated role in reducing neonatal mortality. These practices are distinct in important ways from more broadly recognized (and clearly impactful) interventions like kangaroo care and exclusive breastfeeding, and they are recommended for both preterm and full-term infants. A large evidence base indicates that immediate SSC and EIBF substantially reduce neonatal mortality. Many randomized trials show that immediate SSC promotes EIBF, reduces episodes of low blood sugar, improves temperature regulation, and promotes cardiac and respiratory stability. All of these effects are linked to lower mortality, and the biological pathways between immediate SSC, EIBF, and reduced mortality are compelling. A meta-analysis of large observational studies found a 25% lower risk of mortality in infants who began breastfeeding within one hour of birth compared to initiation after one hour. These practices are attractive targets for intervention, and promoting them is effective. Immediate SSC and EIBF require no commodities, are under the direct influence of birth attendants, are time-bound to the first hour after birth, are consistent with international guidelines, and are appropriate for universal promotion. Their adoption is often low, but ceilings are demonstrably high: many low-and middle-income countries (LMICs) have rates of EIBF less than 30%, yet several have rates over 70%. Multiple studies find that health worker training and quality improvement activities dramatically increase rates of immediate SSC and EIBF. There do not appear to be any major actors focused specifically on promotion of universal immediate SSC and EIBF. By contrast, general breastfeeding promotion and essential newborn care training programs are relatively common. More research on cost-effectiveness is needed, but it appears promising. Limited existing

Summary: The NAO will increase our sequencing significantly over the next few months, funded by a $3M grant from Open Philanthropy. This will allow us to scale our pilot early-warning system to where we could flag many engineered pathogens early enough to mitigate their worst impacts, and also generate large amounts of data to develop, tune, and evaluate our detection systems. One of the biological threats the NAO is most concerned with is a 'stealth' pathogen, such as a virus with the profile of a faster-spreading HIV. This could cause a devastating pandemic, and early detection would be critical to mitigate the worst impacts. If such a pathogen were to spread, however, we wouldn't be able to monitor it with traditional approaches because we wouldn't know what to look for. Instead, we have invested in metagenomic sequencing for pathogen-agnostic detection. This doesn't require deciding what sequences to look for up front: you sequence the nucleic acids (RNA and DNA) and analyze them computationally for signs of novel pathogens. We've primarily focused on wastewater because it has such broad population coverage: a city in a cup of sewage. On the other hand, wastewater is difficult because the fraction of nucleic acids that come from any given virus is very low,[1] and so you need quite deep sequencing to find something. Fortunately, sequencing has continued to come down in price, to under $1k per billion read pairs. This is an impressive reduction, 1/8 of what we estimated two years ago when we first attempted to model the cost-effectiveness of detection, and it makes methods that rely on very deep sequencing practical. Over the past year, in collaboration with our partners at the University of Missouri (MU) and the University of California, Irvine (UCI), we started to sequence in earnest: We believe this represents the majority of metagenomic wastewater sequencing produced in the world to date, and it's an incredibly rich dataset. It has allowed us to develop

Recent cuts to US government foreign assistance have destabilized global health programs, impacting some of the most cost-effective interventions we’ve found for saving and improving lives, such as malaria nets, malaria chemoprevention, and community-based management of acute malnutrition. This situation is a major focus of our research team at the moment, and we’re working to balance a targeted, near-term response to urgent needs with a broad, long-term perspective of needs that may emerge. The US has historically provided roughly 20% to 25% ($12 billion to $15 billion) of the total global aid to support health programs, which combat malaria, tuberculosis, HIV, maternal and child health issues, and much more.[1] While the long-term effects remain uncertain and exact numbers remain difficult to ascertain, cuts of 35% to 90% of US foreign aid dollars are being publicly discussed by the administration.[2] We’ve created a webpage to provide an overview of how we’re responding, and we’ve started to record a series of conversations with our research team that shares timely snapshots of this rapidly evolving situation. Our first episode shared a broad overview of the impacts of US government aid cuts and GiveWell’s initial response. In our newly released second episode, GiveWell Program Officer Natalie Crispin joins CEO and co-founder Elie Hassenfeld to zoom in on a specific case, focusing on grants we’ve made to support urgent funding gaps for seasonal malaria chemoprevention (SMC). They discuss how SMC campaigns work, the impact of USAID funding pauses on SMC campaigns, and GiveWell’s response to keep SMC campaigns on track.   Listen to Episode 2: Addressing Urgent Needs in Seasonal Malaria Chemoprevention   This situation is changing daily, and we’re constantly learning more. You can listen or subscribe to our podcast for the latest updates and read a summary of key takeaways from each podcast conversation on our blog. GiveWell has so far directed approximately