This is a transcript for the AMA with Rob Mather, CEO of AMF, which I recorded live on the 19th of December. To listen to a recording of the live AMA as a podcast, follow the link above for the RSS feed, or:
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The questions for the AMA, which were edited and supplemented to, can be found on the original AMA post.
Hosting an AMA as a live event, followed by a podcast and a transcript, is a bit of an experiment for us, so please do comment or Forum dm me with any feedback you might have.
All of your (and my) questions to Rob are in bold, so you can skim them quickly.
Thanks to Rob Mather for his time, and Dane Magaway for her help with this transcript.
AMA with Rob Mather, recorded 19th December '23
Toby Tremlett: Welcome to this live AMA with Rob Mather, CEO of the Against Malaria Foundation. I'm Toby Tremlett, the EA Forum's content manager. If you're interested in effective altruism, you've probably heard of Rob's charity, the Against Malaria Foundation. For almost two decades, they've been doing crucial work to protect people, especially children, from malaria.
To date, around 450 million people have been protected with malaria bed nets from this charity. Once all of their currently funded nets have been distributed, AMF estimates it would have prevented 185,000 deaths. And it's not just AMF saying this, they've been a GiveWell Top Charity since 2009.
So to get straight into the AMA, we're going to keep the answers pretty short and snappy. I think Rob said he's going to stick to two minutes per answer. And yeah, Rob, thank you for making the time for coming along for this.
Rob Mather: Pleasure.
Toby Tremlett: On the theme of making the time, somebody said that they've organized two small fundraisers with AMF, and in both cases, you were incredibly proactive and helpful, taking time to immediately respond to emails and hop onto calls. They say many thanks, but a question remains, where do you find the time and which time management strategies do you use? You have two minutes of time.
Rob Mather: I don't use any particular strategies, I'm afraid. I think what I would say is we certainly leverage technology here, so that a lot of the things that I perhaps would normally do as a CEO of a charity I don't do because technology takes over. And perhaps I can give a couple of examples.
One of the things that we have to do as a charity is we have to file our accounts. We have to do that, in our case, in 14 countries and there are typically between 10 and 15 documents we have to prepare for each country. Lots of documents, lots of information that would normally take months of a number of people probably putting that together. And we broadly have that content all available to us within nine hours of the end of our financial year because at the end of the day, finances are just ones and zeros so we can automate the living daylights out of it. And therefore a whole series of effort that would otherwise go into admin that would take my time effectively is struck down to just a sliver of time. I think that's one element [that] allows me to put my time in [another] direction.
The second thing I would say is that the structure of AMF is very streamlined. We're very focused on what we do. There is a lot of complexity in many ways around distributing nets, particularly around the operations. That's the bit that really requires an awful lot of very careful attention to make sure nets get to people. And because we have a very simple series of steps, if you like, that we go through when we're carrying out our work, we're not a complicated organization. So strategically, certainly AMF has been designed to be operationally simple. I would say that that simplicity plus technology allows me to have more time in certain areas than perhaps other people might have
Toby Tremlett: Fantastic! That was almost bang on two minutes. Another question: what did you do before AMF? Did it lead naturally into this role or did it feel like a major career change?
Rob Mather: Major career change, really, because I certainly wasn't planning to be in this role. Did it lead into this role? In some ways, yes, because I guess the experiences that I've had and the things that I've learned over my career, I’ll go through it in 30 seconds, in a moment, I think allowed me to not be brilliant at anything, but allowed me to have experiences and some degree of capability across a whole series of areas. Therefore I could cover a lot of bases, particularly in an organization that just had two of us for the first 10 years. We grew to 50 million in revenue with just two of us because of some of those strategic choices about how we were organizing what we did.
When I left university, I studied chemical engineering at university. I went to join a strategy consulting firm. I went to live in Italy, work for a big American company and learned a lot in those four years about strategy, about business, and about getting things done. I then went to business school, learned a huge amount of business school over two years, went to the States. When I came back from the US, moved back to the UK and worked in an exhibitions business, a trade shows business, a very small company, so highly entrepreneurial. And I was effectively a commercial director - I was in charge of one aspect of the organization's business, bringing in revenue with several others, not just me alone. That taught me all sorts of things about how to secure funding if you like. Then I worked in one of the world's largest financial publishers, and I set up a business within a PLC that taught me an awful lot about operations and making things happen and persuading people to do things. And that was the last step before I then effectively set up AMF.
A whole series of different experiences that meant that I felt it was worth giving a go to what I want to do with malaria.
Toby Tremlett: Fantastic. So, would you mind briefly telling the story of how you went from organizing a swimming fundraiser for a horrifically burned child to running one of the most effective global health charities in the world, in two minutes.
Rob Mather: Well, I suppose when we first set up AMF, there was a very simple aim: raise funds, purchase nets, distribute them so that they ended up over heads and beds, and make sure we had the data to prove it. In essence, that very simple approach is the approach we take today. If you layer on top of that very high levels of accountability being at the heart of what we do, we don't accept sort of trust and we don't accept, “well, it probably happened”. We're ruthless about making sure we have the data to prove that what we say we will do happens. That is a very important or very helpful thing to be able to then be transparent about in talking to people about what you're doing. In being accountable, you tend also to embrace efficiency. That combination of accountability at the heart of what we do, being really transparent, always aiming to be highly efficient in the way we go about our work means that in the causal area that is malaria that clearly independent of us, arguably, you know, is a strongly a highly impactful area to be operating in - that combination, I guess, has led us to be independently judged by others to be, you know, pretty efficient and impactful at what we do.
Toby Tremlett: Fantastic. Yeah, I mean, it's interesting, it often comes up in thinking around effective altruism, that it can be surprising that people don't focus on this kind of accountability and measurement when they're making charities. But it does seem to be the case that it's not the thing that most people are thinking about when they're starting charities.
Why was that something that mattered to you? Yeah, I feel like when you had the popularity of this swimming fundraiser which like led into AMF it could naturally, you could have started a charity on something that was salient to you or something that was nearby. Why was it that malaria appealed?
Rob Mather: The reason that malaria was the focus was because when we organized a swim for a burns victim, a small child called Terry who was very badly burnt when she was two that led to 10,000 people swimming from a plan of having three people swimming. That was very surprising. I learned a number of interesting things from that. Most importantly, how terrific people can be in saying, “Yep, we'll help.”
When the notion crossed my brain of trying to get a million people to do something the next year or in a couple of years time, when you think about where you want to direct the funds we might raise from that, it was very clearly low-income countries was was going to be of interest rather than high-income countries - not heart disease and cancer, but HIV AIDS, TB, malaria, landmines, freshwater diarrhea, you know these sorts of issues whereas we all know there is a significant, the larger impact per dollar than in in the high-income countries.
When I discovered that, when I went through each of the six or seven things that I was considering and scratched beneath the surface, there were reasons to dismiss all the others, but seven jumbo jets full of children under five, or the equivalent thereof, dying every day from malaria, and it being the single largest disease killer of pregnant women in the world, yet the most effective thing we could do was have people sleep under a bed net was something that was pretty engaging. And I like the idea of raising money for nets rather than for drugs. You know, big bad pharmaceutical companies might come to mind for some people. So malaria was the obvious target and 5 million nets were going out at that time and the need was 205 million. And so there is a gap. Let's see if I can do something to try and help that.
Toby Tremlett: Yeah, I mean, it's fantastic. It makes total sense in retrospect as well. I was just wondering at the time, had you been thinking about global health before that, or was it just the size of the amount of money you thought I might be able to raise that made you think about it in this way? Like what prompted that?
Rob Mather: Well, actually, it was more random, perhaps in some ways than that. I wanted to try and get a million people to do something. I was inspired by somebody I met in the US a number of years ago, who when she was 18 raised a million dollars for a cancer charity. And I thought, wow, a million dollars. That's a very large amount of money. And here we're going back to the 80s. So we're going back a long time ago when she raised that money. I heard about it a little bit a few years after that. So the idea with World Swim, you mentioned that when we started Toby, was to try and get a million people to do something. My aim was actually to do that for two years: spend a year planning it and then year organizing it. And then I was going to go back and get a proper job. So no, there was no intention of me, there's no forethought about how much money can be raised. It's just let's do you know one thing.
It's very difficult. If I asked you what you're going to do in the next year, you probably got a good answer for me. The next three years, next five years, it becomes more challenging. I certainly had no vision that far in advance. And so I guess my aims were just, I want to try and get a million people to swim. I think we can raise some money. It will raise some awareness because wow, a lot of people don't know about this thing called malaria as far as I could tell from talking to a lot of people and doing some reading and so on. The idea was let's see if we can do something. I'm really up for doing it and I've got some plans as to how I'd like to do it. But this will be a one off. But it attracted a lot of support and interest. And a number of individuals said you can't stop now nor did I want to because I thought, Hey, there's something here. Then we sharpened our focus and our operational elements over the years sort of became much more refined. But broadly, the strategy we started out within those first two years, I guess, has remained the case for the next 17.
Toby Tremlett: Fantastic. Thank you. Yeah, a little bit of a different question here: what is your top advice for new charity entrepreneurs?
Rob Mather: Wow, that's a really broad question. And I guess a really good one, because I've been asked it before. I guess the first thing I would say, and I'm echoing some words, or stealing some words from Dustin Moskowitz. He gave a talk at Berkeley, I think, a number of years ago, where his advice to people in setting up a charity, if that's what you're referring to with charity entrepreneurs, is there's only one reason for you to do it, and that is because you can't not do it. And I guess that talks to, you know, a very, very high level of interest and a passion in doing something. You don't do it for reasons of, you know, money or control or title or whatever else it is. You do it because you feel really strongly about it because that strength of feeling and commitment will take you through the inevitable tough times that most people experience where something doesn't go right for some reason. So, I think that's the first thing: does it sort of come from here, you know, this bit of you in terms of saying I want to do it.
I think there's some practical advice I give people when they're setting up and, and in the early stages of charities, and I work with quite a lot of charities now in that capacity. The first thing I would say, and it's not as though one size fits all, but I think I've yet to come across a charity who wouldn't have found this helpful for them. Firstly is to raise three years money up front so that you don't find you've raised a year's money six months in you're thinking, “Oh, I'm going to run out of money in six months time. I need to start focusing on fundraising.” It also acts as a really good acid test as to whether or not you've got support out there from people. I mean, the other two pieces of advice I often find I give is don't write a business plan. Just sit down with your voice in front of somebody who's going to fund you, that's your start and just tell them what it is you're going to do. And if you can't do it in a minute, then something is probably wrong. And bring a software engineer in house. That's the other thing I would say, which maybe most people do these days, but it's key.
Toby Tremlett: Great. Yeah, thank you. You mentioned earlier that it has been important from the start that you're going to be collecting information from the people who are distributing the bed nets. How do you collect information from those people and then collect feedback from the end recipients of bed nets if you do, and how does that feedback inform the program?
Rob Mather: We do collect a lot of information from the recipient of bed nets primarily through post distribution monitoring programs. So we distribute nets, but it doesn't stop there. Millions of nets go out to millions of households. We then fund at AMF what we call PDMs (Post Distribution Monitoring) where we go back on a nine monthly basis to one and a half percent of the households that receive nets, randomly selected, to establish net presence, use, and condition. During that process, there is a lot of exchange of information captured within a series of questions, all of which are pretty much focused on can we take actions on the basis of the answers, because yes, you can get sort of anecdotal information that can sort of make you think, but really you want to gather information that is usable in some way.
The post distribution monitoring survey or questionnaire that we ask allows us to understand aspects of use of nets and other household relevant parameters, if you like, but we're not generally adjusting course dramatically because there is a simple truth that malaria is transmitted by malaria carrying mosquitoes. They generally bite between these hours - 10 o'clock at night and 2 in the morning. If you cover people with a net at that time and even if it has holes and rips and tears, because it's a long lasting insecticidal net, and mosquitoes don't do an aerobatics maneuver through a hole, they land on the net, pick up insecticide, and that causes knockdown, kills them. That's what works. So It's sort of refining information that we gather more than anything else, rather than any sort of fundamental, direction change we might want to embark upon.
Toby Tremlett: Awesome. Thank you. If you were starting AMF today, is there anything that you would be doing differently?
Rob Mather: I've thought about that a lot because I find it's unsatisfactory that my answer to that question is no. I sort of think surely there's something I would have done differently. But when I think about the main things that happened when I started AMF, I think I’d do them all again in that order. You know, thinking about what it is I want to do and why and how I'm going to do it. And how can I get the financial backing so that I've got a number of years’ money in the bank, even though I've literally done nothing. So there's somebody else that sort of shares the belief and the vision, if you like, and then who are the right people I put in place to execute on that and make it happen. I guess it gives evidence to the simplicity of what we did at AMF at the start. And I guess what we still do today. It was just Andrew and I, my colleague Andrew and I for the first 10 years. Andrew and I had worked together in a previous life. He was my head of technology in a previous life, so we knew each other well. We know each other very well now, because we worked together for more than 20 years. Andrew is very, very talented as a software engineer effectively. And so I had a very clear view of what we needed to do. And also through discussions with the previous Swim For Terri - I'd seen how terrific people were both in the corporate environment and as individual volunteers. I felt there was the possibility of putting significant support in place pro bono that would give us access to supporters because they put their hand up and said, “Hey, I'm going to help.” And additionally, we wouldn't have to spend money that many other charities have to, and your percentage admin rates look really bad. Those key things that we did at the start, I'd do again.
Toby Tremlett: Great, thank you. I like this one: can you talk us through, as transparently as you can, the costs and benefits of being so transparent?
Rob Mather: Good question. It might be more than two minutes for this one. I think the first thing I'd say is that you need to come up with the right ideas and sort of processes first of all. That's a sort of starting point. The vision and plan of what you want to do, but you're going to be transparent about. That's thinking time. There's no cost to that. Then you need to deploy the relevant technology. There's not a lot of cost involved in that. It's more of a sort of mindset of how you're using technology that allows you to gather data, echo out data, [and] share data.
Overall, the process here about what you're gonna be doing and how you're going to execute on being transparent, there's not much cost in that. I think when you are transparent, you tend to keep things simple because you're communicating to people so you need to keep things simple. And that allies very closely with efficiency, you tend to become really quite efficient.
The cost, I think, is sort of relatively low in being transparent. Maybe somebody will come up with a cost I haven't thought about but can't think of one big one. What does transparency do in terms of its benefits? Wow, lots. I mean, in some ways I'm going to echo some of the words I mentioned before it facilitates accountability. No question. It helps you become more efficient because you're being transparent. I think it drives the use of technology throughout the organization because you're wanting to share things. You've got to use technology to get it quickly and echo it out. I think that ultimately leads when you're transparent to high levels of confidence in the organization. We never didn't trust, but we don't ask for people's trust. But we do want to develop people's confidence in us, partners, others. And I think, I guess extending, that it encourages support from donors. And all of that allows us to have more impact. So, you know, you can see the key words there in the benefits, cost’s pretty low.
Toby Tremlett: Nice. Yeah. I mean, I think that's a good answer to a pretty broad question. So, thank you for that. How does the availability of malaria vaccines change AMF’s strategy going forward, if at all?
Rob Mather: It doesn't for the moment [Note that this AMA was recorded on the 19th of December, 2023]. And that's because the malaria vaccines that we have at the moment, whilst they are fantastic additions to the toolbox, the tools that we use to fight malaria, I think it is reasonable to say that they're relatively modest tools, unbelievably fantastic scientific breakthrough and the scientists that have achieved that are to be congratulated hugely because this is the first time we've had a vaccine for a parasite. You know, COVID et al is a virus, as we all know. So that's been a major breakthrough. I think the comparison I would use when it comes to how useful a vaccine will be so RTSS and M21 are the two vaccines, and they have broadly a 35 to 65 percent efficacy. I may be wrong, but my understanding is that the second vaccine is, may well be heading towards a similar 35 to 50% efficacy and I do apologize to the vaccine scientists if I'm explaining that incorrectly.
I think it's useful to look at polio for parameters you want to look at what percentage of the population benefit from the vaccine? Polio 100%. How effective is the vaccine? Polio 100%. How many administrative events with polio? One - on a sugar cube or an injection. Are there any cold chain logistics? Polio vaccine? None. If you have to refrigerate, obviously, it's more expensive. With the malaria vaccines, we're looking at 35 to 50-ish percent efficacy. We're looking at a subset of the population, albeit an important one under fives, but only a subset of that. Three administrative events one month apart, another one a year later and cold chain logistics. So it's not quite there yet. We hope the scientists, you know, the same scientists or others will build on those success and maybe in the next, I'm led to believe 7 to 10 years, we'll be talking about a vaccine in slightly different terms. We hope so.
Toby Tremlett: Awesome. I mean, I guess I wonder, how would it change your strategy? Like how closely are you following it? If it [a malaria vaccine] gets rolled out in a specific country, would this make a difference to how you prioritize where your bed nets are distributed?
Rob Mather: We are following it very closely and potentially it would and I think what we have to look at is what is the most effective means of preventing malaria. There are certain things that I think we could do in a vaccine environment that would leverage the capabilities and strengths that we have. I could see there being a future in which AMF might say to donors, we've done some work over the last year or 18 months or two years where we've explored operationally how we could contribute to vaccine rollout or distribution and we think we have a role to play. So if people would like to contribute to us, this is what we're going to do. I could see that happening potentially in the future because I think some of the strengths and experiences that we've had over the years might put us in a position where we could assist, but we would look at that very closely to see whether or not AMF was the right organization. It might be that there are other organizations that are better placed than us. We'd have to evaluate that.
Toby Tremlett: Thank you. Another question on your distributions: A forum user called JBentham asks: “I noticed that on your distribution page, you have distributions penciled in for the Democratic Republic of Congo up to 2025. Are these distributions contingent on additional funding? If not, which countries would you be most likely to expand your distributions to in 2024 and 2025 if your funding cap was closed?”
Rob Mather: So anything that we publish is funded. We don't announce a country or a region in a country publicly unless it's funded because we need to sign a legal agreement with the government and it would not be the right order if we were to make public that we were going to fund nets for a particular area if we hadn't had all the very important operational and data-related elements of a legal agreement fully signed up to. So they are funded.
There are still huge gaps in DRC in the 2024, 2025, and 2026 period. In fact, $145 million worth of gaps, which means that currently the Global Fund, ourselves, and the American government who are all contributing funding to the DRC three-year campaign, because we're looking at a three-year campaign, it's not done year by year, you're talking about a country that is two-thirds the size of Western Europe and it has some very challenging logistics. The lead times are really, really the two or more years in a sense of minimum. So we've got roughly 62 percent of the population able to be covered and 38 percent not able to be covered and none of the three funding partners have any idea where more funds are going to come from yet.
So we're very, very worried. And I'm afraid the numbers will translate into… unless we close that gap, and as I say, we have no idea where the funding is going to come from, It already includes some projection of how many, how much will come in over the next sort of couple of years… we're looking at about 30,000 people dying.
So it's a really critical situation. Other countries where we've got gaps in funding are Nigeria, Mozambique, Cameroon, Uganda, Chad, South Sudan, Zambia, Guinea and there are others. So we've got more than a $300 million gap right now that we could allocate, so significant opportunities.
Toby Tremlett: Yeah, I mean, just a follow up on that. It's really intense to be working on something where there's 30,000 people kind of in the balance on this on just this particular aspect how do you keep the right level of motivation to work on this so that it's obviously urgent, but it doesn't feel overwhelming? I mean it’s gotten so big, there’s a lot of people involved in this now.
Rob Mather: Yeah, it got so big, but there are only 13 of us. I mean, it's still a small team. I guess none of us need any more motivation than I guess those numbers in that one country. And there are at least 10 countries that are like that, that people die and people fall really sick because they don't have something as simple as a bed net. I guess no extra motivation needed.
And, you know, I guess I'd say two things about myself. One is that I am the world's greatest cynic when it comes to charity, I'm afraid. If I thought I was cynical 19 years ago when I set up AMF, boy, am I cynical now, given what I've seen in international aid. There are some really, really good organizations out there. But there are some things that happen that are led by others that are not very good at all, which is why we do what we do in the way we do it. We focus on data. We're not perfect. We don't have all the answers. We learn all the time, but we're very driven by a particular approach that we stick to. I think it's a very honest one and it's focused on data. I suppose when you are thinking about hundreds of millions of dollars, it's natural for all of us to think, well, what, what difference can I make? I mean these numbers are huge. Every $2 matters. You know, people who know AMF will know that refrain. Every $2 broadly buys a net and that net protects two people. And I can tell you that the net is pretty important for the two people who sleep under it. So there's no amount that is too small, so to speak, or inconsequential. And we do the best we can. We work as hard as we can within limits. You know, we don't work 20 hours a day, that wouldn't be productive anyway, in the long run. We just try and work efficiently and smart. So I'm constantly trying to think how we can do things better to, you know, close funding gaps. We get people giving us a hundred dollars and a thousand dollars, and then some people give us much more. Whenever a donation comes in, it's thrilling because we know what we can do with it.
Toby Tremlett: Thank you and you're doing great on sticking to the two minutes. It's almost exact. So, here’s a question kind of related to this. Now that you have a bigger team, have you found that comes with more overhead in people management, internal communications and stuff like that? What have been the difficulties of growing the team out from a two-person team for a decade to a massive team of thirteen?
Rob Mather: Bottom line is not much of a difficulty because we've only gone from two to 13. So we're still a family in that sense, you know where we [have] strong communication between the vast majority of people most of the time. I mean, not everybody speaks to everybody every day, but we're remote, we don't have offices, which means that we have the benefit of then being able to choose a talent pool that is all over the world in many cases. Although there are limits because we need time zones to coincide broadly to be efficient. Clearly, there have been [costs] when you grow from 2 to 5 to 7 to 10 to 13, you're spending more time on recruiting, you're spending more time on developing people. But those are all pretty pleasurable things - you come across some great people. And what we're always trying to do is sort of square peg in square hole is finding people who've got the background, the characteristics, desire, talents that fit what we try and do. And it's really rewarding when a number of people have been with AMF for a long time now. Their level of knowledge is very, very high. Their abilities are really strong and we're bringing on others in the same way who are doing a really good job. So, you know, modest, you know, it's been a great run over the last five or six years when we've added people to the team.
Toby Tremlett: Brilliant. Yeah, another question, I guess, about how you run this organization: AMF fundraises separately for its operational costs and for the direct costs of its interventions, as far as I understand. How important has this been for AMF's growth and its popularity?
Rob Mather: Going back to the points I made about putting three years' money in place, I didn't want to have to worry about raising money and take my eye off the sort of operational ball, if you like. We've been very fortunate in having a small group of donors, three effectively, who've said, you know, we'll fund the central cost sort of in perpetuity, pretty much. I don't want to take their generosity for granted going forwards because for the money we might need in three years time, we haven't received yet, but you know, that seems to be the way that they view us. I think it's been very helpful that our overheads as an organization are low. The average of the last five years is our overheads as a percentage of revenue have been about 6 or 7%. Obviously that's really quite low partly that's because we don't pay for anything other than 11 salaries of the 13 staff, 11 draw salary. We have some expenses when people fly to Africa for obvious reasons. But banking, accounting, legal website, offices, translation, you name it, we don't have it. It's zero because we have a lot of pro bono support. We put that in place and that's covered. And there are a number of large donors that provide funding that covers the monitoring costs, which are significant. For every 100 million we spend on nets. We spend about seven or eight million on monitoring because we monitor the living daylights out of things we do in the countries in which we operate. They're also covered effectively. Which means that we can say honestly to donors and potential donors, if you give us 10 dollars, we will spend 10 dollars buying nets because everything else is covered. It is incremental. We will buy another 10 dollars worth of nets. And that's a really simple message to be able to share with people.
Toby Tremlett: Yeah, that's great. I mean, this is another really interesting part of AMF - the amount of pro bono support that you get. And I mean, presumably volunteer support in your distributions because people obviously have to give out these nets. How does that happen? And how did you arrive at that way of doing things?
Rob Mather: So we fund the nets, and other co-funding partners cover the non-net costs of the distributions. The non-net costs include shipping, in-country transport of nets, registration across millions of households there a lot of health workers visiting households and gathering data), and then the distribution of the nets. These are typically the next step. We fund the nets at roughly $2 a net. The Global Fund or the American government fund the non-net costs, roughly $2 a net. So if we're putting 20 million worth of nets into Uganda, as we've just done and are closing out the distribution there, the non-net costs would have been funded by or were funded by the Global Fund. We partner with them. There's no volunteering going on there. There are some volunteer activities that go on in-country, but the work that's done in-country is done by people who are paid for PDMs and are on salaries. It's just that we don't pay for that.
When there's a funding gap… Uganda had a $140 million worth of funding needed for the campaign, I think the Global Fund put in $80 million, if I'm not mistaken, the American government put in $20 million, and there was a gap of $40 million. So we said, we'll come in with $40 million to buy the nets because the case was made in terms of malaria genuine funding gap. In fact, it was $20 million we put in, I beg your pardon. And we bought roughly 10 or 11 million nets, and the non-net costs were funded by others. So that part is a partnership, not volunteer helping in-country. That wouldn't work for a nationwide logistical campaign.
Toby Tremlett: Thanks. I mean, that makes a lot of sense. I was wondering how that part of things works. That's very interesting. Another thing that potentially could change the way you think about this going forward is the rise in insecticide resistance. How has this changed your estimations of the impact of bed nets?
Rob Mather: The impact has not gone down very much. I mean, it's gone down by, you know, a number of percentage points, perhaps. We haven't done any particular work to say, is it three? Is it five? Is it eight? Is it perhaps as much as 10? What has happened is that new products have been developed. So rather than having, let's call it a standard net that's got a pyrethroid on it, then we've got nets that have got other active ingredients on it. In one case, a chemical called PBO, piperonyl butoxide, which is a chemical that's safe for humans, but it switches off in the mosquito, the mechanism that causes resistance. So, aha! We're back in the game when it comes to lower levels of knocking out mosquitoes, not zero, but lower levels because they've developed some resistance.
And there are other types of nets that are being developed. When I say types of nets, there are other active ingredients being added to nets. We have a chemical called pyriproxyfen and one called chlorfenapyr. There will not be a test at the end of this hour. But these are chemicals that are added to nets because they act on mosquitoes in a different way and deal with the resistance. Some of these products are showing really promising results. AMF a number of years ago put eight and a half million dollars effectively into a randomized controlled trial to gather the data that would allow us to say whether or not these PBO nets I mentioned worked and if they did in what circumstances and to what degree. That was a very important RCT because it gave us the data, gave all of us the data that said this is how these nets work. And now there are tens of millions of these nets being deployed annually because we all needed the data to support what products we distribute to deal with insecticide resistance.
Toby Tremlett: Awesome. Yeah, thank you. A few of these are questions from Habiba who's starting a charity called Spiro to work on TB. I had a few questions, some of the ones about starting the charity are from her. She asks in what situations does it seem like a good idea to start a new initially small charity rather than supporting existing efforts? So, for example, looking from the outside of malaria work in 2005 when you started your charity, one might have felt like this was a huge area with a lot of attention from big global health organizations, and it'd be surprising if a new small organization could be able to bring something different and useful that existing organizations couldn't. So yeah, how did you think about this and how do you think about this question?
Rob Mather: Sometimes there are lots of tankers on the sea and there aren't enough speedboats. And I guess the smaller organizations can do things slightly differently. They're more agile, can do things in a very different way. Maybe a tanker doesn't focus on data, but a speedboat does. I don't want to take the analogy further because I'll probably drown. But no pun intended. But I suppose it's whether, in reflecting in the field you're looking at, is there a need for some activity or intervention or some way of doing things that doesn't currently exist? It is not the case that incumbents have got it right. Often times have moved on and they haven't moved on and it's really time for a change. And it's assessing whether there is an organization that's really well placed to pivot or whether a new organization is needed. And I guess a new organization often comes with people with that passion I mentioned earlier, desire, and commitment. Maybe they bring in new funding, which can be helpful for the particular causal area. So I think if you assess and there's a need for newness, then, hey, go for it. Try it. Because the worst that can happen is you can fail (dot, dot, dot) and learn a huge amount from doing so. That's not really failure. I guess there'll be pros and cons of any individual situation. But I guess that would be my high-level take.
Toby Tremlett: Great. Thank you. On what frequency do you think about organizational goals and strategy internally? Do you set quarterly goals? Think about big picture strategy annually? How do you think about strategy? When do you course-correct?
Rob Mather: I guess all the time. I think strategy is a fancy word for choices. And you know, I don't think choices are made on a quarterly basis. Choices are made on a daily basis, multiple times a day. And often somebody might look at you, you know, three months on and say, oh, you've sort of adjusted your strategy a bit here. And you may have done because you're making slightly different choices, but it's probably made up of, in most cases, the fact that you're doing 50 things slightly differently and better. So often it's not about a major strategic change. I guess you could say that those choices lead to improvements. But we're constantly thinking about, are we doing this in a way that is maximizing or optimizing our impact? Are we collecting data in the right way? Can we do it without spending so much money? Should we be doing things we're not doing to give us greater confidence in some of the data in this particular circumstance? Should we be deploying technology in a new way, because now we can scan barcodes of nets or whatever it might be? And, you know, I'm constantly thinking about that.
At the same time, the flip side of these sorts of thinking and these sorts of choices is risk. And a lot of what I do each day is thinking about risk, de-risking certain situations so things don't happen all the way from people you want in the organization not leaving, people in the organization developing so we maximize their enjoyment and their productivity, to maximizing the percentage of nets that are overheads and beds. So I guess the answer to your question is all the time.
Toby Tremlett: So you've mentioned the work of the Global Fund. What's your opinion of the other kinds of work that the Global Fund funds for malaria prevention other than, other than bed nets? And would you mind outlining briefly in your answer what else they fund?
Rob Mather: Sure. So I think when it comes to most things in life, the portfolio approach is pretty good. And when it comes to malaria control, there are a portfolio of things that we need to do. I mean, the jigsaw puzzle that is the solution to malaria has probably got about 12 pieces in it: Nets, rapid diagnostic testing kits (RDTKs), indoor residual spraying, ACTs (Artemisinin Controlled Therapy: it's the drug you take three days of it flushes malaria parasite from your system. Very, very effective), health system strengthening (that runs from making sure that malaria data is recorded accurately, because if it's not, then we don't know what we're dealing with, and we don't know if we're improving, to the training of staff in health centers to deal with blood slide analysis of potentially with malaria.) The Global Fund effectively puts money into all of the aforementioned and more things and it's really important it does. RDTKs, ACTs, health system strengthening, or HSS as we refer to it, are all really important. You can't not do any of these things. Sometimes in a country, you get to the point where health system strengthening has really suffered because there's just not been enough money and there have been other priorities and urgencies, if you like, and it gets to the point where you sort of got to go, "Whoa, whoa, whoa, time out. We've got to put money into health system strengthening because unless we do that, things are going to start to fall apart and undermine aspects of these fundamental programs."
I’m a big fan of money going into all of these things. I know that there are evaluators that look at AMF and others and look at the net program, but you can't just do a net program. It's really important that it's funded well. But you can't do that and have other things at really low levels. You need the engine in the car, funding nets, but you also need the wheels and a steering wheel and some other things. Probably a bad analogy, but there we go.
Toby Tremlett: No, I think that makes sense. And that's good to hear because I think often when you hear about AMF as an example in effective altruism, it's not as part of an integrated picture of how we're tackling malaria. It's as an example of exactly what AMF does. I've mostly heard about bed nets, so it's great to hear that there's so much else going on.
Rob Mather: And much of that jigsaw puzzle, Toby, sorry to interrupt, is that SMC, Seasonal Malaria Chemoprevention, is now a really important part of the toolbox that we have. But again, if we had 12 pieces to the jigsaw puzzle before, that is the solution to malaria, it's now 13.
Toby Tremlett: Yeah, that makes sense. So, someone mentioned that AMF has leveraged corporate support and partnerships, perhaps more than other charities do. Does that seem true to you? And if so, is it something that you think lean nonprofits should be doing more?
Rob Mather: I think the simple answer is yes, that we do leverage it more than others. And I guess the second answer to your second question is yes. I think we're within our two minutes, so I should probably expand on that. It's been really humbling over the years to go to people to phone people up and say, "Who do I speak to in your industry who'd be willing to do this thing pro bono for free because I don't think you need a $5 more than a couple of kids in Africa need a bed net?" I can honestly say that in 19 years, when I've asked that question, I've obviously chosen the person I've spoken to with intent and carefully, I know my ground and, and so on. So there's some preparation involved. But in 19 years, I've never, ever had any other answer to that question in any other, in any area in which I've asked it than the one word answer I get, and that is "me." And I go, "Really?" And they say, "Yeah, we'll help you." And I think what that shows is that there are lots of people out there who are willing to help. Obviously, there is a strategy behind asking and what you ask for and how you ask for it, which I probably don't have time in two minutes to go into. But, it's not particularly rocket science. It's largely rooted in common sense. Certainly, we've experienced terrific support. I know other charities have, some of whom I now work with, but I think there are very few charities, I would argue, that probably don't have a number of areas in which they could reduce costs and improve, through collaboration, some of the things they do by engaging pro bono support, because there are lots of people that are willing to help.
Toby Tremlett: Yeah, that's great to hear that it's been so successful. I know that it might take a lot longer to express this, but do you have any tips for that [getting pro bono help as a charity]? Why do you think that's been the case? Is it based on how you pick these people? Like, is it networking? What's going into that success?
Rob Mather: It's not networking, actually. I chose not to network in any stage of setting up AMF. I mean, I probably had a Rolodex that I could have dipped into, but I really didn't want to because I didn't want people to say, "Oh, what's Rob up to now? Yes, we'll support him." I wanted it to be a somebody who, you know, did not know me and looked at the, you know, the merits of what I was suggesting. And if they were to say, "Yeah, look, this is really interesting. We're happy to back this," then I think you have a better indication, you're onto something. I think it's picking areas of support where the ask you're going to make of the people you're going to approach is not such that they're going to go, "Wow, that's a lot." It's a relatively modest contribution, and it might be interesting in year one, but then because of that contribution and the work and the heavy lifting that's done, the support you're effectively going to ask of them is going to be much reduced in future years. It doesn't hit that screen of people saying, "Wow, we're really spending a lot of money effectively or foregoing a lot of revenue in providing this support." I think you develop some experience of who to ask and sometimes when to ask them at what stage in your progress is right to ask them. Those factors have all been part of when I have approached people. In the first couple of years of establishing AMF, there was a lot of thought that went into that. But what I described to people was just a genuine situation and said, "Would you be in a position to help?" There was no cleverness. It was really just going to somebody and saying, "This is where we need help. Will you?" And we had terrific responses.
Toby Tremlett: Right. Yeah. Thank you. Finally, what does the relationship between AMF and the effective altruism community look like from your side?
Rob Mather: It's a pretty warm one. I mean, certainly my sentiment towards the EA community is pretty warm because significant funds have flowed to us from effective altruists. They've also flowed to us from many others, some of whom have not heard of EA, or what it's about. But when I first spoke with Peter Singer many years ago and with Toby Ord and with Will MacAskill and others, there was clearly a sort of alignment of thinking, of how we saw the world in some ways, which I guess in a very uncomplicated way is, there are a lot of opportunities to help people in a pretty fundamental way.
And so personally, I have that view. And I think a lot of people within the EA Movement have a fundamental generosity because it is still remarkable to me the money that is donated to us by some people in terms of a percentage of what they earn. So what we try and do from our side is to be as communicative as possible, both in terms of being really open and transparent with our work and data that surrounds it. And when people approach us from within the EA community and say, "Hey, we've got some questions, or could you appear here and could you tell us about how you do something because we want to find out more?" So it's a pretty warm one for which we're very grateful.
Toby Tremlett: Great. Well, this has been great. I feel like I've learned a lot. It's just some really interesting questions on the AMA. And thank you so much again for your time.
Rob Mather: Pleasure. Thanks a lot, Toby.