Gavi's investment opportunity for 2026-2030 says they expect to save 8 to 9 million lives, for which they would require a budget of at least $11.9 billion[1]. Unfortunately, Gavi only raised $9 billion, so they have to make some cuts to their plans[2]. And you really can't reduce spending by $3 billion without making some life-or-death decisions.
Gavi's CEO has said that "for every $1.5 billion less, your ability to save 1.1 million lives is compromised"[3]. This would equal a marginal cost of $1,607 $1,363 per life saved, which seems a bit low to me. But I think there is a good chance Gavi's marginal cost per life saved is still cheap enough to clear GiveWell's cost-effectiveness bar. GiveWell hasn't made grants to Gavi, though. Why?
I don't think it makes sense to think of these these statements by big NGOs about "lives saved" in the same way as a GiveWell analysis. These numbers are often grossly overestimated often 10x or more. They don't do proper, rigorous cost-effectiveness analysis before making these statements. The CEO's of these huge orgs also can't be expected to understand cost-effectiveness analysis properly. Their job is to be public figureheads and to manage behemoth orgs, not to understand numbers deeply.
Also they say "Your ability to save 1.1 million lives is compromised" which is not exactly saying that extra money would translates to those lives saved. I'm also not clear exactly what they are trying to say, but it may be deliberately vague
My intuition would be that there is a low chance that Gavi's marginal cost per life saved with extra funding is cheap enough to clear GiveWell's cost-effectiveness bar. The first billion of their yearly budget ight be cost-effective, but for marginal extra dollars there are diminishing returns with vaccines, just like there are usually diminishing returns, including with initiatives like mosquito nets and corporate campaigns.
SPECIFIC Gavi programs or initiatives GAVI could be super cost-effective though and that might be worth looking into. An analogy might besprawling big NGOs like CHAI or PATH, which (IMO) do a huge amount of work which isn't cost-effective at all. But GiveWell funds some of their specific programs which might be more cost-effective.
Probably because life-saving interventions do not scale this well. It's perfectly plausible that some lives can be saved for $1600 in expectation, but millions of them? No.
Peter Rossi’s Iron Law of Evaluation: the “expected value of any net impact assessment of any large scale social program is zero.” If there were something that did scale this well, it would be a gigantic revolution in development economics. For discussion, se Vivalt (2020), Duflo (2004), and, in a slightly different but theoretically isomorphic context, Stevenson (2023).
On the other hand, Sania (the CEO) is making a weaker claim -- "your ability...is compromised" is not the same as "without that funding, 1.1 million people will die." That's why she's CEO, she knows how to make a nonspecific claim seem urgent and let the listener/reader assume a stronger version.
Gavi do vaccines, something that governments and other big bureaucratic orgs sure seem to handle well in other cases. Government funding for vaccines is how we eliminated smallpox, for example. I think "other vaccination programs" are a much better reference class for Gavi than the nebulous category of "social programs" in general. Indeed the Rossi piece you've linked to actually says "In the social program field, nothing has yet been invented which is as effective in its way as the smallpox vaccine was for the field of public health." I'm not sure it is even counting public health stuff as "social programs" that fall under the iron law.
That's not to say that Gavi can actually save a life for $1600, or save millions at $1600 each, or that GiveWell should fund them. But impact of literally zero here seems very implausible.
Until a few months ago, about 13% of Gavi’s funding came from the United States. According to admin officials, this funding commitment was rescinded over concerns about Gavi’s approach to vaccine safety and marketing during COVID-19. I don’t attribute much value to the stated reasoning, as it was already expected to be among cuts to US foreign aid around the time the Trump administration took office.
~$300m/year is a big hole to fill in order to maintain existing operations, and there wasn’t much time to evaluate it as a private giving opportunity. Some EA-aligned policy people were able to build bipartisan support while advocating for renewing federal funding to Gavi, but I am not sure where that effort currently stands.
Indoor tanning is really bad for people's health; it significantly increases one's risk of getting skin cancer.[1] Many countries already outlaw minors from visiting indoor tanning salons. However, surprisingly, there are only two countries, Australia and Brazil, that have banned indoor tanning for adults, too. I think that doing policy advocacy for a complete ban on indoor tanning in countries around the world has the potential to be a highly cost-effective global health intervention. Indoor tanning ban policy advocacy seems to check all three boxes of the ITN framework: it is highly neglected; it affects many people (indoor tanning is surprisingly popular: over 10 percent of adults around the world have tanned indoors[2]), and thus has the potential to have a big impact; and also, I think it could be quite tractable (passing laws is never easy, but is should be doable, because the indoor tanning lobby appears to be much less powerful than, say, the tobacco or alcohol lobbies).
I'm initially skeptical on tractability -- at least of an outright ban, although maybe I am applying too much of a US perspective. Presumably most adults who indulge in indoor tanning know that it's bad for you. There's no clear addictive process (e.g., smoking), third-party harms (e.g., alcohol), or difficulty avoiding the harm -- factors which mitigate the paternalism objection when bans or restrictions on other dangerous activities are proposed.
Moreover, slightly less than half of US states even ban all minors from using tanning beds, and society is more willing to support paternalistic bans for minors. That makes me question how politically viable a ban for adults would be. "[T]he indoor tanning lobby" may not be very powerful, but it would be fighting for its very existence, and it would have the support of its consumers.
On the other side of the equation, the benefits don't strike me as obviously large in size. Most skin-cancer mortality comes from melanomas (8,430/year in the US), but if I am reading this correctly then only 6,200 of the 212,200 melanomas in the US each year are attributed to indoor tanning. The average five-year survival for melanoma in the US is 94%. So the number of lives saved may not be particularly high here.
Is indoor tanning worse than outdoor tanning? If not, I can see a ban making sense in cold countries, where people might counterfactually tan, but in countries like Australia and Brazil I can assure you this just has a displacement effect of sending people outside (even in winter).
Yes, indoor tanning is worse for your health than outdoor tanning. Indoor tanning beds beam UV radiation that can be as much as 10 to 15 times stronger than what you get from the sun.[1]
It is worth mentioning that people who use indoor tanning are also more likely to not use sun protection when outdoors[2]. This means that we really would not want to ban indoor tanning if the result is people just spending more time outside in the sun and getting the same dose of exposure. I did not find any studies that have looked at to what extent this is what people do after indoor tanning is banned.
My guess, though, is that a ban would be significantly net positive, even after accounting for a potential increase in outdoor tanning.
Gavi's investment opportunity for 2026-2030 says they expect to save 8 to 9 million lives, for which they would require a budget of at least $11.9 billion[1]. Unfortunately, Gavi only raised $9 billion, so they have to make some cuts to their plans[2]. And you really can't reduce spending by $3 billion without making some life-or-death decisions.
Gavi's CEO has said that "for every $1.5 billion less, your ability to save 1.1 million lives is compromised"[3]. This would equal a marginal cost of
$1,607$1,363 per life saved, which seems a bit low to me. But I think there is a good chance Gavi's marginal cost per life saved is still cheap enough to clear GiveWell's cost-effectiveness bar. GiveWell hasn't made grants to Gavi, though. Why?I don't think it makes sense to think of these these statements by big NGOs about "lives saved" in the same way as a GiveWell analysis. These numbers are often grossly overestimated often 10x or more. They don't do proper, rigorous cost-effectiveness analysis before making these statements. The CEO's of these huge orgs also can't be expected to understand cost-effectiveness analysis properly. Their job is to be public figureheads and to manage behemoth orgs, not to understand numbers deeply.
Also they say "Your ability to save 1.1 million lives is compromised" which is not exactly saying that extra money would translates to those lives saved. I'm also not clear exactly what they are trying to say, but it may be deliberately vague
My intuition would be that there is a low chance that Gavi's marginal cost per life saved with extra funding is cheap enough to clear GiveWell's cost-effectiveness bar. The first billion of their yearly budget ight be cost-effective, but for marginal extra dollars there are diminishing returns with vaccines, just like there are usually diminishing returns, including with initiatives like mosquito nets and corporate campaigns.
SPECIFIC Gavi programs or initiatives GAVI could be super cost-effective though and that might be worth looking into. An analogy might besprawling big NGOs like CHAI or PATH, which (IMO) do a huge amount of work which isn't cost-effective at all. But GiveWell funds some of their specific programs which might be more cost-effective.
Probably because life-saving interventions do not scale this well. It's perfectly plausible that some lives can be saved for $1600 in expectation, but millions of them? No.
Peter Rossi’s Iron Law of Evaluation: the “expected value of any net impact assessment of any large scale social program is zero.” If there were something that did scale this well, it would be a gigantic revolution in development economics. For discussion, se Vivalt (2020), Duflo (2004), and, in a slightly different but theoretically isomorphic context, Stevenson (2023).
On the other hand, Sania (the CEO) is making a weaker claim -- "your ability...is compromised" is not the same as "without that funding, 1.1 million people will die." That's why she's CEO, she knows how to make a nonspecific claim seem urgent and let the listener/reader assume a stronger version.
Gavi do vaccines, something that governments and other big bureaucratic orgs sure seem to handle well in other cases. Government funding for vaccines is how we eliminated smallpox, for example. I think "other vaccination programs" are a much better reference class for Gavi than the nebulous category of "social programs" in general. Indeed the Rossi piece you've linked to actually says "In the social program field, nothing has yet been invented which is as effective in its way as the smallpox vaccine was for the field of public health." I'm not sure it is even counting public health stuff as "social programs" that fall under the iron law.
That's not to say that Gavi can actually save a life for $1600, or save millions at $1600 each, or that GiveWell should fund them. But impact of literally zero here seems very implausible.
Until a few months ago, about 13% of Gavi’s funding came from the United States. According to admin officials, this funding commitment was rescinded over concerns about Gavi’s approach to vaccine safety and marketing during COVID-19. I don’t attribute much value to the stated reasoning, as it was already expected to be among cuts to US foreign aid around the time the Trump administration took office.
~$300m/year is a big hole to fill in order to maintain existing operations, and there wasn’t much time to evaluate it as a private giving opportunity. Some EA-aligned policy people were able to build bipartisan support while advocating for renewing federal funding to Gavi, but I am not sure where that effort currently stands.
Indoor tanning is really bad for people's health; it significantly increases one's risk of getting skin cancer.[1] Many countries already outlaw minors from visiting indoor tanning salons. However, surprisingly, there are only two countries, Australia and Brazil, that have banned indoor tanning for adults, too. I think that doing policy advocacy for a complete ban on indoor tanning in countries around the world has the potential to be a highly cost-effective global health intervention. Indoor tanning ban policy advocacy seems to check all three boxes of the ITN framework: it is highly neglected; it affects many people (indoor tanning is surprisingly popular: over 10 percent of adults around the world have tanned indoors[2]), and thus has the potential to have a big impact; and also, I think it could be quite tractable (passing laws is never easy, but is should be doable, because the indoor tanning lobby appears to be much less powerful than, say, the tobacco or alcohol lobbies).
https://www.aad.org/public/diseases/skin-cancer/surprising-facts-about-indoor-tanning ↩︎
https://www.aad.org/media/stats-indoor-tanning ↩︎
I'm initially skeptical on tractability -- at least of an outright ban, although maybe I am applying too much of a US perspective. Presumably most adults who indulge in indoor tanning know that it's bad for you. There's no clear addictive process (e.g., smoking), third-party harms (e.g., alcohol), or difficulty avoiding the harm -- factors which mitigate the paternalism objection when bans or restrictions on other dangerous activities are proposed.
Moreover, slightly less than half of US states even ban all minors from using tanning beds, and society is more willing to support paternalistic bans for minors. That makes me question how politically viable a ban for adults would be. "[T]he indoor tanning lobby" may not be very powerful, but it would be fighting for its very existence, and it would have the support of its consumers.
On the other side of the equation, the benefits don't strike me as obviously large in size. Most skin-cancer mortality comes from melanomas (8,430/year in the US), but if I am reading this correctly then only 6,200 of the 212,200 melanomas in the US each year are attributed to indoor tanning. The average five-year survival for melanoma in the US is 94%. So the number of lives saved may not be particularly high here.
Yeah, it looks like the impact is probably not that big, if compared to say lives that could be saved via alcohol or tobacco control policy advocacy.
Is indoor tanning worse than outdoor tanning? If not, I can see a ban making sense in cold countries, where people might counterfactually tan, but in countries like Australia and Brazil I can assure you this just has a displacement effect of sending people outside (even in winter).
Yes, indoor tanning is worse for your health than outdoor tanning. Indoor tanning beds beam UV radiation that can be as much as 10 to 15 times stronger than what you get from the sun.[1]
It is worth mentioning that people who use indoor tanning are also more likely to not use sun protection when outdoors[2]. This means that we really would not want to ban indoor tanning if the result is people just spending more time outside in the sun and getting the same dose of exposure. I did not find any studies that have looked at to what extent this is what people do after indoor tanning is banned.
My guess, though, is that a ban would be significantly net positive, even after accounting for a potential increase in outdoor tanning.
https://www.npr.org/sections/shots-health-news/2025/12/14/nx-s1-5640088/tanning-bed-users-are-at-higher-risk-of-skin-cancer-especially-in-unusual-places ↩︎
https://jamanetwork.com/journals/jamadermatology/fullarticle/2565799 ↩︎