Love this great work! I think we need more careful, thorough but straightforward explanations like this. Understanding why some charities are better than others can often be harder than we think to people outside our bubble.
Hi Sjir - This is a great article and appropriately challenging for those who haven't thought about this before. I agree with your summary message. I also agree that it's a sensitive exercise to compare in this way, but choosing such a fundraising colossus to compare to makes it much more palatable, in my view.
With regard to the broader St Jude’s mission, you limit your research discussion to the impact of St Jude’s on advancing cancer treatment for children in the USA. However, St Jude’s is an international resource that runs a large global oncology program, including in LMICs. They work with a collaborative network of 400+ hospitals on capacity-building, education, their “Global Platform for Access to Childhood Cancer Medicines”, quality improvement tools, research, and policy work with WHO and national governments - thus potentially magnifying their impact significantly. This is important work with the rising importance of non-communicable diseases in LMICs. But like most global health programs run out of academic institutions in high income countries, the focus is not on cost effectiveness.
It’s unlikely that factoring these global activities into your calculations will fundamentally change the summary message. But it’s notable what might be achieved by convincing St Jude’s (and other academic health science centres in high income countries) to redirect some of its massive budget ($2.7B annually and rising rapidly) to its global programs in LMICs, and to focus on improving the cost effectiveness and marginal impact of those programs.
How some charities save lives 100x more efficiently than others
I often get asked how our effective giving recommendations compare to some of the larger charities people are already familiar with.
Here I’m going to make one such comparison, showing why GiveWell’s Top Charities, which we recommend in global health, are likely more than 100x more cost-effective at saving children’s lives from preventable and curable disease than St. Jude Children’s Research Hospital, one of the world’s largest charities in terms of funds raised from private donors.[1]
This is an inherently sensitive thing to do and easy to misinterpret, so I want to be very clear and upfront about my position. I think St. Jude does important work that actually saves children’s lives, and I think it’s good for the world that it exists and that donors are giving to it. I’m not making this comparison to argue against St. Jude’s work. Rather, I’m making the case that, if we care about saving children’s lives, we should also save them when we can do so much more cheaply.
I think it’s necessary to make a comparison like this because in my experience, many people aren’t compelled by effective giving through broader arguments only: they need concrete examples to make sense of the claim that they can 100x their impact. That claim by now has a small literature supporting it, suggesting large differences in cost-effectiveness between interventions and charities, why and how these differences arise, and that donors often underestimate them. If we don’t dare compare directly to charities people are familiar with, many may merely believe this a theoretical or niche exercise, and continue to give less based on effectiveness than they think they do.
I believe that if more people were to internalize what this 100x multiplier on their impact means, and unlock the power they can have through their giving, we can together solve world problems which may have seemed insurmountable, and save and improve many lives along the way.
A simple comparison
A caveat up front: I’m going to make the comparison in the simplest way possible, make a few shortcuts, and avoid a lot of details and nuance that would go into a full evaluation and cost-effectiveness analysis. For example, I will compare core programs and outcome measures only.[2] In particular, I’ll address what I think is the most relevant question we can ask for these charities: how much does it cost their core programs to save one child’s life? This is not the only question we should care about, but it’s one that captures a lot of what these charities and their donors are trying to achieve, and allows for a relatively apples-to-apples comparison.[3]
GiveWell documents the cost to save a child’s life extensively and transparently for the charities they recommend.[4] They estimate an average cost to save a child’s life of between $3500 and $5500 for their Top Charities over the past few years, so I’ll take $4500 as the estimate for the purpose of this comparison. I trust GiveWell’s estimates as they are based on tens of thousands of hours of research, and our research team at Giving What We Can has evaluated the quality of their research and methodology and found it to be exemplary.
We don’t have high-quality impact data for St. Jude, but we can make a generous estimate on their cost of saving a life by looking at the average treatment costs for childhood cancer, which is the disease they focus on most. St. Jude itself has claimed that “treatments for pediatric cancer can last up to three years or more and cost on average $425,000, including housing, travel and food.” This sets a lower bound on St. Jude’s cost to save a life through cancer treatment: it can't be cheaper to save a child’s life than to treat that child. And this lower bound estimate already shows a roughly 100x difference with the $4,500 cost of GiveWell recommended charities.
There are multiple reasons to believe St. Jude’s actual cost to save a child’s life from cancer is much larger than this $425,000 lower bound. For example, a quick check for independent sources shows their self-reported cost of treatment is likely an underestimate: this study finds a mean cost of $564,000 for 927 patients in the US more broadly, and St. Jude also claims it “specializes in care for some of the toughest pediatric cases”.
Moreover, not every child treated is saved.[5] And even more significantly: without St. Jude’s existence, most of the children it treats would likely still be saved. ProPublica found that 90% of St. Jude’s patients are insured, which suggests they could have been treated at other US hospitals. Many of these aren’t funded by donations to the extent St. Jude is, and are comparably good to St. Jude at treating childhood cancer. So in many cases, donations to St. Jude may not cause a child to be saved but change where they are saved and who pays for it.
What about research impact?
St. Jude is explicitly a research hospital, not just a treatment hospital. So you might expect its biggest impact on saving children’s lives will be through research improving childhood cancer treatment in the US, rather than providing the treatment itself. We can again set a rough bound on cost-effectiveness here, this time by looking at the total size of the problem St. Jude is aiming to solve and the resources they are deploying to solve it.
There are about 1,600 children and adolescents dying annually from cancer in the US, among about 15,000 diagnosed, down from about 2,200 annual deaths twenty-five years ago. As a father to a 5-month old daughter myself, and more generally, I hope we’ll one day be able to bring these numbers down to zero, and I’m happy St. Jude is working on this. But to put it into perspective: at St. Jude’s current ~$2.8B annual budget, they would need to save ~600,000 children’s lives every year to be comparably cost-effective at saving lives to GiveWell’s current recommendations.
To save 6,000 annually, and be even 1/100th as cost-effective, St. Jude would need to single-handedly significantly reduce the 150,000 global annual childhood cancer deaths through its research, without increasing treatment costs a lot. This is not impossible but seems unlikely, as most of global deaths are due to problems with access to care rather than lack of treatment options, and St. Jude is only one of multiple actors in the research field.
It matters which problem you work on, and where
The above points at one of the key drivers of the difference between St. Jude and GiveWell’s recommendations. The former works on a problem that is much less sizeable, overlooked, and solvable than, say, malaria, which has cheap, underfunded solutions, and still kills nearly half a million children every year. Even if you’re the most competent charity in the world in terms of how you work, the problem you work on will put a limit on your potential to be cost-effective.
On this point, there’s actually reason to think St. Jude’s work may become more cost-effective over time, as it has recently started to expand internationally. Their global efforts still constitute only ~4% of their overall budget,[6] but this is a very promising direction, considering the relative childhood cancer disease burden and need for funding and treatment in low- and middle-income countries.[7] Even if it doesn’t become as cost-effective as GiveWell’s recommendations at saving lives, St. Jude is bound to do an amazing amount of good if it successfully expands these efforts.
The bottom line
I think we should continue the fight against childhood cancer. I think we should also pick up the fight against diseases like malaria, and in other high-impact causes, and that we should take large differences in cost-effectiveness seriously when allocating our limited resources. I believe the children served by GiveWell’s recommendations are as deserving of help as those served by St. Jude, and that we should work towards a world where enough money is provided so all of these children no longer need to die of easily preventable diseases.
The good news: if you’re reading this, you are, like me, probably in a great position to help!
I would be curious to get reactions and feedback from readers on this comparison. Are you surprised by the outcome? Do you think there should be more comparisons like these, or that there’s something problematic in making them? Are there important points you think I have missed?
Appendix: Why this comparison?
There are a few reasons why I chose these two particular giving options to compare:
St. Jude does good uncontroversially, and I want to avoid spreading the frame of “effective giving is good because most charities aren’t”. There are examples of near-useless or potentially even harmful charities, but I think most charities have a significant positive impact, and I think it’s great that people are donating to those charities rather than (for example) spending their money on luxury goods for themselves. Effective giving is about recognizing there are often even better opportunities out there to help.
St. Jude is a candidate for the largest single-entity private fundraising charity in the world, with more than 11 million donors and with ~$2.8B raised from private donors in 2025 (accounting for nearly 0.5% of all US giving).
GiveWell’s recommendations and grantmaking make up a significant part of effective giving spending, accounting for more than $500M of the $2B moved to effective charities last year.[8]
It’s possible to make this comparison based on publicly available data.
St. Jude and GiveWell’s recommendations work towards a similar goal: they both try to save children’s lives from preventable or curable disease. It’s easier to compare them than to compare two charities that work on different goals, for which we need to make ethical assumptions on how to value different outcomes that many people will disagree on (e.g. see here if you’re interested in GiveWell’s approach to this). This is certainly worth doing, but beyond the scope of this article.
I will not discuss diseases other than childhood cancer St. Jude works on, because these constitute a minority of their work (e.g. in their strategic plan $3.7B was allocated to cancer-related care vs $1.1B to other diseases). And I will also not discuss other outcome measures than children’s lives saved, as the latter is St. Jude’s main focus.
People sometimes raise that a charity like St. Jude saves different children than GiveWell-recommended charities do. They may acknowledge children in Sub-Saharan African countries are as deserving of a good life as children in the US, but argue that a child saved in the US will have, on average, a much better life ahead of them after being saved, and so saving that child is more valuable. I think there are at least three counterpoints to this meaningfully affecting to our comparison: (1) GiveWell-recommended charities often prevent children from getting disease rather than treat them, which means they won’t suffer the long-term effects from disease that St. Jude’s patients may have; (2) life in low-income countries is significantly harder, but it’s difficult to argue a child’s life there is only half as good as that of a child in the US, much less 1/100th (e.g. life expectancy in Sub-Saharan African countries is 63 vs 79 in the US, and they score worse on most but not all well-being metrics); (3) life in many of these countries has the potential to significantly improve, meaning children born today could have much better lives than those who came before them, though this is far from guaranteed (and may depend in part on our actions!).
I am writing up two charity ideas I’ve wanted to investigate, but haven’t been able to, in the hopes someone will investigate them further. If you end up investigating either, I'd be most interested to see what conclusions you come to!
Vulture preservation as a global health intervention
Since the mid 1990's the vulture population in India has been rapidly declining. The reason is due to a few chemicals which are fed to livestock, which is highly poisonous to vultures.
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Epistemic status: Wrote this pretty fast, probably ~70% confident some version of the thesis claim is true, would welcome being proven demonstrably wrong.
Context: I’m a grantmaker focused on alt-protein and am fairly well-connected/moderately in the loop of what animal welfare grantmakers are doing.
This post was significantly inspired by “...
Love this great work! I think we need more careful, thorough but straightforward explanations like this. Understanding why some charities are better than others can often be harder than we think to people outside our bubble.