Thanks for this write up. I had no idea about any of this! I'm as bit disturbed by Makary's response to your "change your mind" question. Character, integrity, balance, and ability to compromise really matters when it comes to leading institutions, not just being smart and having good ideas.

Making new discoveries is often helped by some contarianism yes, but I'm not sure it's the best trait for running an institution. 

Like you I hope they will do well!

Although it's an interesting question, I'm not sure that gaming out scenarios is that useful in many cases. I think putting energy into responding to the funding reality changes as they appear may be more important. There are just so many scenarios possible in the next few months. 

PEPFAR might be the exception to that, as if it gets permanently cut then there just has to be a prompt and thought through response. Other programs might be able to be responded to in the fly, but if The US do pull out of HUV funding there needs to be a contingency plan in place. Maybe gaming scenarios is useful there, but only if whoever is gaming it actually has the influence either to fund scenarios that do arise, or informed those that fund. Maybe the WHO is doing this but they aren't very agile and don't communicate much on the fly so it's hard to know 

I think pepfar and malaria tests and treatment donations are among the most important and large scale funding gaps that need to be considered responded to in the short term. Even if stocks remain for the next few months, if they aren't delivered because those organizing their delivery didn't have jobs then that's a big problem.

I do think that governments need to take some responsibility too. If you have the medications you probably can switch manpower to delivering them, even if you hadn't budgeted for it because you expected USAID was going to fund that indefinitely. This is the situation for malaria and HIV commodities which are often there in decent quantities but sometimes aren't being distributed effectively right now.

The vast majority of other USAID programs I don't believe are super cost effective, so as super sad as it is that they are gone and no longer helping people, I don't think it's wise to consider covering their funding in most cases as that money would be better spent on more cost effective charities. 

The reason for this global trend is because Global income inequality has decreased globally (mainly because of India and China's development), whereas within individual countries in general inequality has been increasing over the last 50 years - which is what matters most in people's perception. At the level of the nation state, which is what matter socially, inequality has drastically increased - especially right at the top end of wealth.

I agree with Pinker that inequality is not quite as bad as a lot of people think, but wanted to get the facts right here.

Thanks Tom! No I wouldn't generalise that broadly, I'm sure there will be some cases where it might be cost effective to get some bridging funding in there. For me it's less about the nature of the program, and more about whether there's are tipping points in the vulnerability of the people being cared for.

If we take top GiveWell charities as an example, in situations like mosquito nets, vitamin A, distribution, deworming if those stopped for a year they could probably be started again fairly easily in a year without disproportionate harm. The lives lost would mostly be just because there were less nets delivered (the same as is they had less funding in the first place), not because of some disastrous vulnerability exposed.

A counterexample which might have merit to fund might be something like a malnutrition program where you are halfway through giving rutf to 100,000 kids. Maybe you have enough RUTF to feed the kids but USAID has cut funding for staff. Lots of benefit from the first half of the program would be lost of you didn't fund staff for the second half. Maybe this would be worth paying the staff to finish the program - assuming it's a relatively good malnutrition program without hugely bloated salaries as USAID projects often have. In saying this you could probably offer the staff half their USAID pay to come back and finish the program and nearly all would - even more cost effective (this might sound callous but I have discussed it here before)

Or something like a highly effective gender based violence program that was halfway through - you might have very little benefit for people if the program remained unfinished, so finishing it might really be worth it.

I'm not saying most projects are "resilient" as such - without funding they will stop. Just that most could be restarted again relatively easily in future without huge extra expense.

The problem is you can't trust NGOs to tell you the truth on this - almost all are hardwired to use disasters in any way they can to raise more money. You'd have to investigate the real situation on the ground pretty hard. I was horrified during covid how many NGOs unrelated to health managed to make spurious arguments why they needed way more money. 

By the way if anyone is considering funding stuff on a big scale in East Africa, in happy to get on a call and give you my 10 cents ("my 2 cents is free")

I don't have a big issue with much of this philosophically, I'm just extremely skeptical about the validity of most small percentages.

My intuition is that small percentages are often greatly overestimated, therefore giving far higher expected values then is really the case. My inclinations is that where uncertainty is greater, numbers are often exaggerated. Examples where I have this intuition is in animal welfare and existential risk. This seems like it should be testable in some cases. Although it might seem like a strange thing to say, I think conservative small percentages are often not conservative enough. 

Often I think that pascall's mugging is a mugging as much because the "low" probability stated is actually far higher than reality, than just because the probability is low persay.

I don't have any data to back this up, obviously we overweight many low probabilities psychologically, things like probability of aeroplane crashes and I feel like its the same in calculations. This has almost certainly. been written about before on the forum or in published papers, but I couldn't find it on a quick look.

Thanks for this initiative! My somewhat thought through take from someone who knows a bunch of people who lost their jobs and who's work has been mildly but meaningfully affected by USAID cuts is that I would be slow to throw money at projects previously funded by USAID. 

1. Most USAID projects just won't be the most cost effective place to put your dollar, even if cost effectiveness might be slightly increases by providing a bridge to get them restarted. As much as cutting the aid abruptly is doing large amounts of harm and feels terrible, if the original project is only moderately cost effective it might still not make sense.
2. Most orgs and projects are often surprisingly resilient to pauses, especially in sub Saharan Africa. There are very few cases where the work wouldn't be able to restart in a few months if funding was returned from somewhere else. This points to me against the "bridging" argument drastically increasing cost effectiveness above what it would have been for the project anyway.
3. f you do choose to get involved, talk to a lot of people before deciding. Other funders are thinking the same thing  about whether to get involved in similar initiatives, and they might have done a bunch of research on it too. For example I know GiveWell are thinking about this too.

4. I don't love that the site doesn't have actual links to the work that's being funded. For example one case seemed super dubious to me "East Africa, one entity cannot make a $100,000 purchase of life-saving HIV/AIDS medications and another cannot purchase $50,000 worth of nutrient-dense foods for children, both because of the freeze on U.S. foreign aid."

   To the best of my knowledge. East African countries still have enough HIV meds for a few months at least, and I don't know much about of parallel programs that would purchase medication separately like this. I'm not saying it's necessarily wrong but I'd like to hear more.

I really like these frameworks, lots of interesting communication ideas, and I do think some of the old EA communication classics have find a bit stale. I especially like the blue ocean thing. Nice job! 

Ha I love this I will definitely check that simulator out nice one!

This is fantastic thank you! Have already sent it to someone considering dong a CBA

"For any purpose other than an example calculation, never use a point estimate. Always do all math in terms of confidence intervals. All inputs should be ranges or probability distributions, and all outputs should be presented as confidence intervals."

I weakly disagree with this "never" statement, as I think there is value in doing basic cost-benefit analysis without confidence intervals, especially for non mathsy indivuals or small orgs who want to look at potential cost effectiveness of their own or other's interventions. I wouldn't want to put some people off by setting this as a "minimum" bar. I also think that simple "lower and upper bound" ranges can sometimes be an easier way to do estimates, without strictly needing to calculate a confidence interval. 

In saying that when, big organisations do CBA's to actually make decisions or move large amounts of money, or for any academic purpose then yes I agree confindence intervals are what's needed!

I would also say that for better or worse (probably for worse) the point estimate is by far the most practically discussed and used application of any CBA so I think its practially important to put more effort into getting your point estimate as accurate as possible, then it is to make sure you're range is accurate.

Nice job again.