Prioritizing COVID-19 interventions & individual donations

By IanDavidMoss, catherio @ 2020-05-06T21:29 (+85)

UPDATE 7/23: Our group has concluded research activities for the time being. Previous updates have been moved to the bottom of the post. All information and recommendations below are current as of late June 2020. If you have questions or are considering a donation, feel free to reach out to one of the authors and we will help you if we can.

Authors: Catherine Olsson and Ian David Moss, with contributions from the collective members of the "Funding Rational Actors Promptly" Pandemic Endowment (FRAPPE).

At the beginning of April, a group of about 20 friends pulled together a messenger chat to discuss how to most effectively spend personal donation funds towards mitigating global suffering caused by COVID-19. What started as an informal effort has since resulted in the distribution of at least $398,000 to charities on this list and indirectly influenced $16 million in additional capital, mostly via the decisions of a single large foundation.

A defining motivation of our group was to find time-sensitive and neglected bottlenecks to effective COVID response that could be eased with rapid funding or other supportive actions. Fast action can be an important source of philanthropic leverage in responses to the current pandemic, a factor that we did not see explored in depth in available analyses of COVID-related giving opportunities. Accordingly, we have summarized our research here in hopes that others can use it to inform their own giving.

This article is organized in two parts. The first shares our working framework for prioritizing interventions, which helped us get oriented in a fast-changing and otherwise confusing landscape. In the second part, we enumerate specific giving opportunities (jump to section) we have found that currently rate highly on this framework as of right now (late June 2020).

We've written this post primarily for the benefit of donors who have already decided to focus on COVID-19 for their own reasons. We haven't made it a priority to weigh the relative value of COVID-related donations as compared to other issues or causes, although we address this briefly at the end.

Some disclaimers: this research is being done and our donations are being made in a purely personal capacity, and none of us is acting as an employee, representative, or spokesperson of our employer or any other organization. Furthermore, because we don't have complete information on many opportunities and the situation is changing so rapidly, none of what follows should be treated as the final word on COVID-related giving opportunities. With that said, we have tried hard to come to the best decisions we could in a short period of time using the resources we had, and are updating this post periodically as our perspective continues to evolve.

I. Executive Summary & Recommendations

When evaluating COVID-19 interventions for importance/scale, our intuition is to look for the following five "scale factors":

1. ⏰Acting quickly, because widespread avoidable suffering is already taking place, because mitigation is more cost-effective when active case numbers are smaller, and because many potentially impactful interventions require lead time to set up.
2. 🌍Concentrating benefits on the global poor, due to both disproportionate vulnerability and huge numbers.
3. 😷Cheap mitigation strategies to limit or slow the spread of the disease, even in populations where full containment is not possible. We are particularly interested in interventions that are cost-effective relative to the burden they impose on society.
4. 🔬Scientific research & development in support of any of the above facets of the problem, because a dollar spent on research can unlock orders of magnitude more benefit later. This includes vaccines to prevent contraction of the disease, therapeutic treatments that reduce severity for those who have it, diagnostics, and other areas.
5. 📊Knowledge and advocacy to inform and motivate policy responses that are more likely to achieve desired outcomes from a global perspective.

For now, we have recommended the following donation opportunities, as we believe they meet many of these criteria and have room for more funding:

• Open Source Medical Supplies, a grassroots collaboration leveraging the international maker community to design, produce, and distribute medical supply items for hospital workers and the broader community.
• Protege BR, an effort to map, connect, and coordinate a network of hundreds of makers to produce PPE items and distribute them to healthcare workers across Brazil.
• Fast Grants, a rapid-turnaround funding mechanism for research on COVID-19.
• COVID-END, an initiative to enhance collaboration and reduce duplication among parties conducting rapid reviews of research to inform COVID-19 policy.

In addition, we have identified a number of other organizations doing promising work that have the potential to emerge as top recommendations as we learn more about them and/or as their work develops.

II. Big picture: What's the bad thing that's happening? What could cause less of it to happen?

In this section we lay out the basic moving parts of the current crisis that one could intervene on to produce a better outcome. Parts of this section might be obvious to some readers; however, what is "obvious" to some can be "surprising" to others, so we think it's worthwhile to restate the essential picture.

Two things are going on:

• The first-order problem: a disease is spreading around, causing illness that harms people.
• The second-order problem: both the disease and the response are disrupting people's ability to work, consume, move around, distribute goods, and care for themselves and others, which is harming people.

First-order problem: a disease is spreading around, causing illness.

The basic epidemiological picture is as follows:

1. Each person who has the disease infects some number of other people on average.

2. The disease at first spreads exponentially (R0 > 1) within populations of susceptible people who have contagious contact with each other.

• The world is not uniformly mixed, so different "populations" are undergoing different transmission dynamics.

3. If no measures are taken to bring R0 below 1 and there is no vaccine, the exponential spread begins to slow down in a population only when a large fraction of that population has been infected, such that the disease starts running out of susceptible hosts.

• The number of infected people required to reach "herd immunity" is 1-1/R0 (for example, R=3 → 66.7%). However, epidemics have momentum, so a larger fraction of people ends up getting infected ("overshoot"). (see thread by @CT_Bergstrom)

To get a feel for these dynamics, the simulator at https://ncase.me/covid-19/ is the best pedagogical resource we've seen so far.

Graphic by Kristen Tonga for FRAPPE

What levers can we pull to make direct impacts less bad?

1. Reduce the total number of people who get it. For example:

• Mitigate until a vaccine. (See "The Hammer and The Dance")
• Some populations can avoid ever reaching the point of herd immunity / population saturation by deploying a combination of strategies that keep R0 small or even at times below one. Mitigations will need to continue until a vaccine is available.
• Lower the herd immunity saturation point.
• Some populations will be unable to avoid hitting herd immunity, but since the percent of infected population at saturated steady-state is a function of R0, then if R0 can be kept lower (e.g. through wearing masks in public), fewer people get infected.
• Reduce overshoot.
• In populations trending towards herd immunity, a well-timed reduction in R0 near the peak of infection can reduce unnecessary infections from overshoot, at lower cost than maintaining that strategy for a longer period of time. (@CT_Bergstrom)
• Reduce contagious contact between hotspots and susceptible clusters.
• Create and deploy a vaccine.

2. Reduce the amount of suffering per person who gets it. For example:

• Develop and deploy treatments that lower the severity or death rate among cases.
• Spread out the infections within a population over a longer period so that people are treated by a less-overwhelmed medical system, or even just cared for by a less-overwhelmed social support network. (This is one motivation for the "flatten the curve" strategy.)
• Prevent health care workers in particular from getting infected so that the medical system can provide higher-quality care. According to one analysis, applying this intervention in low-income countries offers a cost-effectiveness profile that is competitive with GiveWell top-recommended charities.

Second-order problem: disruptions to people's lives and livelihoods

In addition to the direct health impacts on people who get sick, there are indirect impacts. People who are sick or concerned about getting sick will not work, consume, travel, distribute goods, or participate in their communities at the same rate or in the same patterns as before. Additionally, mitigation strategies (such as lockdowns, test-and-trace programs, mandatory face coverings, or education campaigns) will further shape people's behaviors, as well as costing money. These altered patterns of activity and production, and direct and indirect financial costs, are already manifesting as job losses, food shortages, and other disruptions to people's lives and livelihoods. Particularly in poorer countries, the indirect effects of the disease could cause more harm than the disease itself, as they are not only harmful in their own right but worsen many existing social problems (other diseases, hunger, domestic violence, education, inequalities in access to essential services, etc.).

Some mitigation strategies are much more expensive than others, in terms of both money and disruption. In the case of a previous pandemic, for example, one analysis concluded that "[early] contact tracing was estimated to be 4,363 times more cost-effective than school closures ($2,260 vs. $9,860,000 per death prevented)." While we can't assume that these ratios will necessarily hold for COVID, a similarly wide differential among the cost-effectiveness of different strategies would not be surprising.

Furthermore, some mitigation strategies take much more "setup time" than others (e.g. a school closure can be done immediately, but contact tracing cannot be started until tracers are trained and hired), and yet mitigations are best done when case numbers are low (which is true early in the course of disease spread, or after a successful period of suppression). This means that wealthier places can deploy expensive and disruptive methods early on to buy time to set up cheaper methods later while keeping case numbers low throughout the mitigation process; lower-income areas, by contrast, cannot afford to do so as easily.

Finally, mitigation strategies exist in a policy and information environment that can either facilitate or hinder desirable outcomes. As one particularly high-profile example, the World Health Organization and United States Centers for Disease Control recommended that the general public avoid obtaining or wearing face masks in the initial months of the pandemic, only to eventually reverse those recommendations in the face of new evidence. The fact that these institutions made what was apparently the wrong call early on arguably made it more difficult for public officials to enforce mask-wearing now that it is broadly accepted practice.

What levers can we pull to make indirect impacts less bad?

• Direct (e.g. cash transfers) or indirect (e.g. programs and services) support to people whose lives have been disrupted or are likely to be disrupted in the near future.
• Shift to mitigation strategies that are more effective for their cost, reducing dollars spent and disruption incurred for the same outcome.
• Act more quickly when deploying mitigation strategies, as they are more effective when the case numbers are smaller.

III. Prioritization: Which levers are likely "most effective" to pull on?

When prioritizing interventions, the usual factors to consider from an effective altruist perspective are scale, neglectedness, and tractability. We think that time-sensitivity is another important factor in this case.

Scale

The above "napkin sketch" picture of what's going on yields some quick-and-dirty intuitions as to where the big "scale factors" are.

For one, exponential curves add orders of magnitude very quickly, so reducing the spread of the disease (especially in contexts where it can be done cheaply) is likely to be cost-effective. We emphasize that this is still the case even in communities that cannot avoid a high rate of infection. If a population has not been able to control the disease and cannot afford sustained lockdowns, and therefore may be on track to hit herd immunity before a vaccine is found, we originally entertained the hypothesis that it might not make a difference to the ultimate outcomes to slow the spread. However, we now understand that lowering R0 saves lives in all cases, because it both lowers the herd immunity saturation point and reduces "overshoot" in which excess infections occur above the herd immunity level. These both correspond with vast numbers of lives saved.

Some strategies are orders of magnitude more cost-effective than others. We believe these cheaper strategies may include wearing masks in public, handwashing, contact tracing when case numbers are low, disease surveillance (i.e. finding undetected cases), and personal protective equipment (PPE) for healthcare workers. (see Juneau et al. preprint). We're excited about interventions that make cheap mitigation strategies more available, affordable, and accessible.

We also expect orders of magnitude could be found in substantially reducing the severity of the disease, through developing, manufacturing, and distributing highly-effective treatments.

Existing thinking about the role of leverage in cost-effectiveness can be applied here too. Borrowing from the framework from Open Philanthropy Project's blog post "GiveWell's Top Charities Are Increasingly Hard to Beat," the following sources of leverage are ways to add multipliers to impact-per-dollar:

• Concentrating benefits on the global poor, due to both disproportionate vulnerability and huge numbers
• Knowledge and advocacy to inform and motivate policy responses that are more likely to achieve desired outcomes from a global perspective.
• Note: several well-positioned contacts in our network have informed us that there is currently a lot of "noise" in this space, with many groups leaping forward to provide guidance. Coordinating, unifying, or streamlining this guidance therefore seems likely to be more impactful to us than simply creating more analysis.
• Scientific research & development in support of any of the above facets of the problem (including but not limited to treatments, vaccines, and testing/diagnostics in support of treatment and mitigation strategies), because a dollar spent on research can unlock orders of magnitude more benefit later.

We boil this down to five "scale factors": ⏰Acting quickly, 🌍Focusing on the global poor, 😷Reducing the spread via cheaper strategies, 🔬Scientific research, and 📊Informing & coordinating policy.

Neglectedness, and other properties of the ecosystem & organizations.

We found that estimating neglectedness was critical to our understanding of opportunities, but more challenging than we expected because the landscape of other funders' attention is both difficult to track and evolving rapidly. For example, a simplistic view is that too much money is being spent on "coping with" the pandemic, as compared to "solving" it (see, e.g., the COVID-Zero messaging, and this tweet from Paul Romer). This lens might give the impression that vaccines are currently under-resourced; however, vaccines seem to have attracted a lot more attention compared to other treatments and have received billions of dollars in investment. The simplistic "coping" vs. "solving" lens also misses that many of the world's poorest people need support to literally survive pandemic-induced disruption, not just "cope" with it.

In addition to the usual ITN analysis, we came to realize that acting appropriately quickly is unusually important to an intervention's effectiveness on COVID-19 mitigation. This consideration is not usually called out explicitly in the ITN prioritization framework. In addition to the fact that exponential curves add orders of magnitude very quickly (as discussed above as a "scale factor"), there's the fact that fast-moving actors are rare; it's much more typical for decision-makers to respond slowly. This means that interventions that need to be undertaken quickly seem more likely to end up neglected, due to a lack of actors who can orient and act fast enough to do them. Slow-moving organizations might be appropriate to fund if the intervention is not especially time-sensitive, but if there is a narrow window of opportunity, and the opportunity passes, money spent on the attempt could be totally wasted. Finding an appropriate match between the time-sensitivity of interventions and the promptness of relevant actors is especially key. As a result, some donation opportunities that otherwise look good might not be effective due to a lack of urgency or readiness on the part of the specific potential recipients.

IV. Specific giving opportunities

We highlight first the top few overall giving opportunities we have found so far at this stage of our investigation, followed by other promising candidates by topic area. While we have had limited time to identify and evaluate organizations, we have now reached a point in our research where we feel quite good about most of the opportunities listed below.

Opportunities we plan to give to

Open Source Medical Supplies: 😷Cheap mitigation, 🌍Global poor, ⏰Acting quickly.

• What they do: Open Source Medical Supplies is a remarkable project that started as a Facebook group in mid-March. In its first eight weeks of operation, it had grown to over 74,000 members, published specifications for 20 medical supply items, and created local response guides translated into 40 languages. Most importantly, OSMS has leveraged its international maker community to produce more than 8 million medical supply items by local small-scale manufacturers around the globe. Products created from OSMS's designs have fully supplied some local hospital systems, and Afghanistan's national COVID-19 response plan explicitly leverages OSMS's guide and specifications.
• Why we want to fund them: Since we know the virus spreads primarily via droplets and much transmission is asymptomatic or presymptomatic, face masks are a key part of the solution to controlling the spread. OSMS is one of the few charities we've found focused on rapidly scaling mask production and distribution, alongside other PPE items and even specialized machines like ventilators. One of the co-founders of OSMS was also a co-founder of Maker Faire, giving the group access to a huge global DIY community. The group has also formed a partnership with the Toyota Research Institute and MakersRespond.org, which is a kind of sister initiative focused on rallying professional manufacturers to support the response. As impressive as OSMS's work has been, its reach in poor countries has lagged behind its successes in the US and Europe, and there is a time-sensitive, cheap opportunity to help bolster the initiative's capacity to extend its impact in other areas of the world. OSMS is seeking to raise $300,000 immediately for this and other purposes and an additional $700,000 to sustain its efforts into next year.
• Actions: Our group has directed $20,250 to Open Source Medical Supplies to date. The organization is fiscally sponsored by RESOLVE, and donors wishing to support OSMS can email info@opensourcemedicalsupplies.org for instructions.

Protege BR: 😷Cheap mitigation, 🌍Global poor, ⏰Acting quickly.

• What they do: Inspired by the Open Source Medical Supplies community, Protege BR is an effort to map, connect, and coordinate a network of hundreds of Brazilian makers to produce PPE items and distribute them to healthcare workers across the country. Operated by the Brazilian organization Olabi, it has scaled up rapidly in a matter of weeks, already facilitating the donation of more than 700,000 face shields to the Brazilian health care system alongside other products.
• Why we want to fund them: As of June, Brazil is a humanitarian disaster in the making as a result of the strain put on its health systems by COVID, especially in the country's northern regions. Not only is the Latin America's most populous country bearing the brunt of one of the worst outbreaks in the world, it is doing so with considerably weaker hospital facilities and infrastructure than that available in the United States and Europe. Moreover, Brazilian institutions, particularly the federal government, have done little either to attempt to contain the spread or insulate the populace from the economic effects of the pandemic. Despite all this, the global community has allocated a disproportionately small amount of aid to the region and the major international aid organizations don't seem to be reacting fast enough or operating at anywhere near the scale required. Increasing PPE availability for healthcare workers where supply is scarce is arguably one of the most cost-effective things any donor can be supporting right now, and we can trust that impact scales roughly linearly with investment at smaller donation levels.
• Actions: Protege BR has agreed to work with us to coordinate donations to small-scale PPE manufacturers in Brazil. To make a donation, please write to info@protegebr.org for instructions and copy iandavidmoss@gmail.com so we can help facilitate as needed.

Fast Grants. 🔬Scientific research, ⏰Acting quickly.

• What they do: Fast Grants is a rapid-turnaround funding mechanism for research on COVID-19, mostly but not exclusively biomedical in nature. Marginal donations help more research projects get funded. Project proposals are reviewed by an expert advisory committee and divvied up by expertise area, with decisions rendered within 48 hours. Average project size in the first round of grants was $175,000.
• Why we want to fund them: They focus specifically on funding research that is currently bottlenecked by funding availability and whose outputs could be directly useful on a six-month timescale. Fundraising for scientific research is a notoriously slow and time-consuming process, actively inhibiting the production of relevant knowledge in the current crisis. After awarding more than $20 million in just a month of operation, Fast Grants is now soliciting previous winners for recommendations of new projects to support, and reports steady or even increasing quality of fundable opportunities via this route.
• Actions: Our group has given Fast Grants more than $193,000 to date. If you are interested in donating, please contact fund@fastgrants.org.

COVID-END: 📊Informing & coordinating policy, 🌍Global poor, ⏰Acting quickly.

• What they do: Enhance collaboration and reduce duplication among parties conducting rapid reviews of research to inform COVID-19 policy, so that, e.g. "Rather than have 33 groups conduct rapid reviews on the same or similar questions about face masks in a one-week period (as we recently found), COVID-END could enable these groups to find what’s already there." The program has also developed a prototype for on-demand rapid evidence reviews on any COVID-related question. The 40+ partners involved in the collaboration are among the leading institutions in the field of research synthesis methodology, including Cochrane, the Campbell Collaboration, the Global Evidence Synthesis Initiative, and more.
• Why we want to fund them: We're especially excited about groups that are coordinating, unifying, or streamlining policy guidance, rather than merely contributing to the proliferation of advice in the space. That's exactly what this group works on. The value proposition of COVID-END is a no-brainer and could lead not only to less wasted time and money, but more importantly to better-quality interpretation of evidence by policymakers around the world; for example, they are working directly with the WHO on the technical guidelines and advice being provided to the WHO's member states. Despite its promise, COVID-END is currently operating on a shoestring budget using repurposed funds from other initiatives. We estimate that it could productively absorb at least $200,000 in additional support.
• Actions: Our group has directed more than $157,000 to COVID-END, which is housed at McMaster University in Canada. Canadian donors and those who do not need a tax receipt can donate to the project online here. Non-Canadian donors who need a tax receipt for their respective country can send a check to Friends of McMaster, Inc. at McMaster University, 1280 Main Street West, OJN 432, Hamilton, ON, Canada L8S 4L8. Be sure to refer to the allocation code COVID-END Fund (PJS266A) on the check.

Promising, with some open questions/reservations

Global poor

Medecins Sans Frontieres. 😷Cheap mitigation, 🌍Global poor, ⏰Acting quickly.

• What they do: Medecins Sans Frontieres (MSF) is undertaking a wide range of interventions including construction or setup of COVID wards in hospitals and training/technical assistance to caregivers in many countries around the world, including some poorly served by other aid groups.
• Why we found this opportunity promising: The geographic reach of MSF's COVID response is impressive and it is one of the only organizations actively working to increase treatment capacity at hospitals in the Global South. MSF is GiveWell's go-to recommendation for disaster philanthropy and is a well-regarded organization in the international community.
• Why we didn't rate it higher: At the time we reviewed them, MSF was not making a big push for COVID-specific funding and described its ability to help in the current pandemic as "limited." We believe the organization is doing highly valuable work with its existing resources, but it is unclear to us how additional funds would be spent.

GiveDirectly (International). 🌍Global poor, ⏰Acting quickly.

• What they do: GiveDirectly funnels cash payments to low-income informal sector workers in urban areas of Kenya, Uganda, Malawi, and Liberia. The organization is actively seeking additional partnerships in other countries and ultimately aims to distribute up to $100 million to aid recipients.
• Why we found this opportunity promising: GiveDirectly has been a GiveWell top charity for a number of years and is widely recognized as an outstanding organization. In addition, cash transfers are one of the most-studied forms of aid out there and are particularly relevant during this crisis. GiveDirectly has shown an impressive ability to scale up its US-based activities in response to the pandemic, and we hope to see similarly rapid progress on the international front. In contrast to its more resource-intensive traditional screening process, GiveDirectly is partnering with telcos and NGOs to identify vulnerable populations and expects COVID response funds to reach recipients in one month rather than the usual six months.
• Why we didn't rate it higher: We have great respect for GiveDirectly as an organization, but its current international program mostly reaches countries where COVID outbreaks have been relatively mild to date. The organization is in the process of sourcing additional partners, but its ability to scale up quickly may be limited by the fact that it has only ever operated in several African countries and the United States.

GiveIndia. 🌍Global poor, ⏰Acting quickly.

• What they do: Give about $60-100 to families of unemployed daily wage earners in both urban and rural areas of India, through partnerships with local charities.
• Why we found this opportunity promising: India is the world's second-most populous country and the country's lockdown is likely to make life much worse for the tens of millions there who live in extreme poverty. We thus believe that GiveIndia looks like a promising GiveDirectly-like organization in another part of the developing world.
• Why we didn't rate it higher: Unlike GiveDirectly, we aren't very familiar with GiveIndia and we weren't quickly able to learn enough about the organization's track record to feel confident about recommending donations at this time. We also lack clarity on how much additional funding GiveIndia could productively absorb once its current fundraising target, which is close to being met, is hit.

Development Media International. 😷Cheap mitigation, 🌍Global poor, ⏰Acting quickly.

• What they do: DMI is setting up radio-based campaigns to encourage social distancing, handwashing, and other preventative behaviors in nine African countries. They are up and running in three so far and need funding to expand to the other six (Cote d'Ivoire, Ethiopia, Madagascar, Malawi, Uganda, and Zambia). DMI estimates that the campaigns could increase physical distancing by up to 10 percentage points, meaningfully lowering R0 and slowing the spread.
• Why we found this opportunity promising: DMI is an organization we're already familiar with, named by GiveWell as a standout charity since 2014. This work is highly time-sensitive, as it will be more effective if done while case numbers are smaller; the fact that they are already running their campaigns in three countries tells us they're equipped to act fast enough to capitalize on this opportunity. Although GiveWell recently made a grant to DMI for this work, the organization is still seeking additional funds for this effort. Even if contributions end up funging against DMI's other activities, DMI's non-COVID-related work is also work we feel good supporting, so we are confident that this will be on net a good use of money for the world.
• Why we didn't rate it higher: Although DMI specializes in evidence-based public information campaigns, it is far from the only government or nonprofit entity engaging in such efforts in the current crisis, and it is unclear to us whether the need to conduct such campaigns remains as urgent as was the case early in the pandemic. With that said, our group has collectively given DMI nearly $20,000 and we continue to believe it is a strong giving opportunity.

Africa CDC. 😷Cheap mitigation, 📊Informing & coordinating policy, 🌍Global poor, ⏰Acting quickly.

• What they do: Africa CDC is part of the African Union, working with governments across the continent to coordinate policy responses to the pandemic, such as developing test-and-trace solutions and managing supply chains and stockpiles. It is also producing knowledge resources and tracking policy actions at a regular clip.
• Why we found this opportunity promising: We've been impressed with the pace and clarity of Africa CDC's leadership thus far. By convening national governments, the organization helped to facilitate a response in late February and formalized a continent-wide strategy by late March. It has the trust of major global health funders and multilateral agencies. A strong track record of coherent guidance to shape policy around slowing the spread in lower-income countries is a profile we're excited about. There seems to be an outstanding need for more funding, although the situation is unclear. At the start of April Africa CDC issued a request for $400 million jointly with the African Union (its parent organization); we have only been able to document about $65 million raised since then, with most of that coming from a pledging event on May 5.
• Why we didn't rate it higher: Despite multiple attempts, we were unable to reach anyone at Africa CDC to discuss the organization's current funding needs and priorities. We have gotten the impression that while the organization is doing some great work, it is difficult for individual donors to work with them directly. As a result, we don't have knowledge of meaningful funding constraints that could be bridged with smaller gifts at this time.

Vaccines, diagnostics, and treatments

COVID-19 Early Treatment Fund: 🔬Scientific research, ⏰Acting quickly.

• What they do: Founded by venture capitalist Steve Kirsch, the COVID-19 Early Treatment Fund focuses researching the effects of early, outpatient treatment with a shortlist of promising antiviral medications. The initiative hopes to save lives by a) lowering mortality rates and b) reducing hospitalization burden. The fund targets neglected clinical trials mostly run out of universities.
• Why we found this opportunity promising: Absent a vaccine, effective treatments are the only way to reduce the death and suffering caused by COVID without economy-killing shutdowns or difficult-to-pull-off test-and-trace solutions. Treatments using existing drugs can be made available to the world much sooner than a vaccine, but funding efforts have disproportionately focused on the latter to date. The Early Treatment Fund approaches this work with a unique and compelling theory of change, and its work was endorsed by prominent epidemiologist Marc Lipsitch in a recent podcast interview with 80,000 Hours. It is seeking to raise $20 million, with about 10% of that goal met as of May 20.
• Why we didn't rate it higher: As a new initiative very strongly driven by a single person's vision (read the website if you don't believe us), we see this opportunity as higher-risk than many others on this list. On the surface, there is no reason why other, better funded players in this space, such as the Gates-Mastercard-Wellcome Trust Therapeutics Accelerator or the FDA's CTAP program, shouldn't be funding the clinical trials targeted by this initiative, and even if the Early Treatment Fund is on to something here, its work could become duplicative and unnecessary very soon. We also noted that the initiative's donation page offers some unusual quid-pro-quo language promising "exclusive medical benefits that we cannot make available to everyone (due to the very limited supply)" to entice donors at the $100,000 level and above, which some members of our team felt was highly inappropriate and in tension with our desire to protect the most vulnerable members of society.

ACT Accelerator: 🔬Scientific research, 🌍Global poor, 📊Informing & coordinating policy, ⏰Acting quickly.

• What they do: In early March, a group called the Global Preparedness Monitoring Board articulated an urgent $8 billion funding need to ensure that vaccines, therapeutic treatments, and diagnostics for COVID-19 are developed rapidly enough, manufactured at scale, and delivered in equitable fashion to people all over the world. Since then, governments and civic institutions have engaged in aggressive fundraising efforts to meet that target, finally hitting the goal on May 4. The package of interventions supported by this effort, now grouped under the heading of the ACT Accelerator, is without question the world's most ambitious and important COVID-related philanthropic effort by a very large margin. Beneficiaries include the Coalition for Epidemic Preparedness Innovations, a global partnership making possible some of the most promising vaccine trials currently underway; the new Gates-Wellcome-Mastercard Therapeutics Accelerator, which aims to facilitate the delivery of a non-vaccine COVID treatment to 100 million people by the end of 2020; Gavi, a key partner in the effort to ensure that everyone in the world will have access to a vaccine against COVID-19 when one is available; and the World Health Organization, which is helping the world's poorest countries implement a pandemic preparedness plan that was developed prior to the outbreak.
• Why we found this opportunity promising: Although the $8 billion funding goal has been met, the principals involved have characterized that figure as a mere "down payment" on what will eventually be required, which is estimated to be in the tens of billions. The US government has distanced itself from the effort thus far, despite providing more than two-thirds of global government funding for neglected diseases as recently as 2018.
• Why we didn't rate it higher: Because of the massive amounts of money involved, it seems unlikely that the ACT Accelerator is a good donation target for non-billionaires. However, we suspect that advocacy to urge the US government to support the initiative may be very high-impact. We have found a few attempts to do so by nonprofits such as the ONE Campaign, Global Citizen, and Oxfam, but don't yet know enough about these efforts to be able to recommend them.

1 Day Sooner: 🔬Scientific research, ⏰Acting quickly.

• What they do: 1 Day Sooner advocates for human challenge trials (HCTs) for COVID-19. The hope is that HCTs will speed up the vaccine trial and approval process by allowing Phase 3 trials to be conducted over a much shorter period of time and with many fewer participants by deliberately infecting participants with the virus rather than waiting to see if people get it or not. 1 Day Sooner is currently seeking to raise up to $1.5M for its efforts over the next year, with the bulk of that money going toward producing sufficient quantities of the virus to use as an infectant in an actual challenge trial.
• Why we found this opportunity promising: If everything goes according to plan, human challenge trials could shave off as much as a couple of months from the vaccine development and distribution timeline, which would almost certainly save thousands of lives. Despite a fair amount of public discussion, challenge trials have met with a lot of resistance from the medical establishment thus far, and 1 Day Sooner is the only organization we know of working to change that.
• Why we didn't rate it higher: Challenge trials are a very risky intervention, as they involve intentionally infecting humans with the virus which could obviously result in a lot of suffering, up to and including death, for a very uncertain reward. The organization's work is premised on the assumption that Phase 3 trials are counterfactually much more difficult to conduct, and its promised impact will only be realized if the vaccines being tested actually prove to be effective. In addition, there is a risk that HCTs could play into anti-vaccination campaigners' narratives and decrease trust in vaccines overall.

Policy advice/knowledge/resources

IDinsight: 🌍Global poor, 📊Informing & coordinating policy, ⏰Acting quickly.

• What they do: IDinsight's demand-driven response to COVID-19 includes policy briefs, remote data collection including phone surveys of affected individuals, and direct advising of government entities. GiveWell recently gave IDinsight a grant to bolster its data collection and government advising capabilities specifically, which it is mostly offering pro-bono.
• Why we found this opportunity promising: IDinsight has an immediate $2.6 million funding gap for specific pro-bono COVID-related projects in its pipeline, involving a mix of data support to local and national governments, surveys, and evaluation services. A confidential list of unfunded projects was shared with FRAPPE, and several of these looked quite valuable to us. We have been impressed with IDinsight's thoughtful approach to selecting and prioritizing partnerships on the basis of potential impact and neglectedness. Because the services are provided pro bono and the requests are coming from poor countries where IDinsight has existing relationships, it seems like a reasonably good bet that the specific projects serve neglected needs and that information provided will be acted upon.
• Why we didn't rate it higher: IDinsight's inbound requests are coming from a heterogeneous mix of stakeholders with small-to-medium-sized beneficiary sets. While this patchwork pattern of opportunity is not surprising given the organization's relative youth and modest size, it is in some tension with the global, interconnected nature of the COVID challenge, and we are unsure how to judge the potential scale factors from this approach to service provision.

Center for Global Development: 🌍Global poor, 📊Informing & coordinating policy.

• What they do: Produce high-quality COVID-related briefs and analysis, with a focus on implications for the Global South.
• Why we found this opportunity promising: CGD is well-regarded as an organization by people we trust (such as Open Phil, which sent them additional funding for COVID-related projects recently). They're producing highly relevant and useful content at a rapid pace. Evidence that they're having influence on current policy decisions includes the fact that ACT Accelerator's strategy of using advance market commitments (AMCs) to secure vaccine production emerged from an advocacy effort that CGD initiated in 2005.
• Why we didn't rate it higher: While CGD appears to be doing great work with existing resources, it's unclear what additional donations would make possible. There is no COVID-related appeal on CGD's website.

Rapid Reviews COVID-19 (no link): 🔬Scientific research.

• What they do: MIT Press and UC Berkeley's School of Public Health are in the process of launching Rapid Reviews COVID-19, an open access journal for accelerated curation and peer review of COVID-19-related research. The journal publishes unsolicited peer reviews of selected preprints of scholarly articles posted on public websites like medRxiv, thus providing a layer of quality assurance for important COVID research without interfering with its public availability.
• Why we found this opportunity promising: The proposal cites several examples where poor-quality preprints got picked up in the media and misled the public, or even became weaponized by those with an agenda. If the journal built a strong enough brand, it could therefore act as a vector against disinformation in addition to helping raise visibility for underappreciated research. As of May 21, the initiative has raised enough funding to proceed but could productively absorb at least another $150,000. Additional funding would go toward hiring additional reviewers and increased marketing activities, both valuable uses of resources to deliver on the potential of the project in our view.
• Why we didn't rate it higher: The journal will need to quickly gain a high profile both within the research community and in the media in order to meaningfully shape discourse about emerging research. Achieving that goal is by no means a sure bet, and we weren't sure if the project plan that was shared with us properly reflects the level of effort required to meet the challenge.

What about Johns Hopkins CHS?

The Johns Hopkins Center for Health Security has been the most frequently cited top donation opportunity for COVID-19 so far in EA community writeups such as the Founders Pledge COVID-19 Response Fund and SoGive's post on EA Forum. Pandemic preparedness is core to the center's mission and it has been quite active in the current crisis, having launched a widely followed coronavirus case tracking map/database; it also publishes numerous white papers addressing questions of interest to policymakers and its experts have been prominently featured in the media. There are a few reasons why we have not prioritized it in our own research. For one thing, the profile of the center has been raised considerably as a result of the pandemic and we are unsure what additional funding would make possible in the short term. In addition, the center's track record in providing high-quality advice does not appear to be unblemished; we noted that its experts explicitly recommended against wearing DIY masks in early March (a position reversed by the end of the month) and were not discouraging people from pressing ahead with travel plans as late as March 6, advice that may have led to costly decisions and missed opportunities during a period when infections were rapidly increasing.

Also considered

Other organizations we considered included Partners in Health, PATH, CARE, the Food and Agricultural Organization of the United Nations (FAO), EpidemicForecasting.org, Y-RISE, the Center for Disaster Philanthropy, GiveDirectly (for its US-focused Project 100 campaign), the Emergent Fund's People's Bailout, National Domestic Workers Alliance, Meals on Wheels, America's Food Fund, United Way, Medical Credit Fund, ONE Campaign, Oxfam, Population Services International, and Give2Asia. While we have elected not to pursue these options at this time, we believe they are all doing relevant work and intend to track their activities periodically as bandwidth permits. Complete analysis of all organizations considered is available here.

Certain of these merit mention for donors with specific preferences or priorities that may be different from ours. For example, the Center for Disaster Philanthropy's COVID-19 Response Fund is a good option for donors who want to make a single donation to cover a wide range of interventions globally. For donors interested in helping vulnerable populations in the US, the Feeding America/World Central Kitchen partnership looks attractive on the basis of scale of impact and fast implementation. For US-focused donors with very strong social justice values, the Emergent Fund's People's Bailout could be an intriguing option.

If an organization doesn't appear anywhere in this blog post, it's possible we are not aware of it, or it's possible we were but decided not to investigate it in depth.

Opportunities we wish we'd found more of

Based on our analysis of the big picture, and the important levers we identified, we felt there were a number of gaps in the landscape that we wished we could support, but we could not quickly find as many strong organizations dedicated towards those efforts as we would've hoped to see. (Such organizations may exist, in which case we'd love to hear about them.)

• Advocacy to drive global engagement by the US government. The US has been conspicuously absent from many of the most consequential international efforts to coordinate distribution of vaccines, treatments, and diagnostics to the world's population. Global access to these goods is in the US's national interest since an active pandemic anywhere is a threat to health everywhere. However, it was difficult to find organizations actively working to organize support for these interventions in Congress or other relevant channels. All of the activity we saw was limited to online petition drives, although there may be other work taking place behind the scenes.
• Supporting fast/early contact tracing for lower-income countries. When case numbers are small, contact tracing seems to be one of the most effective and cost-effective strategies in controlling an outbreak (Juneau et al.); however, it has diminishing returns with scale (see guidance from Africa CDC) and thus becomes too expensive for lower-income countries when case numbers get too high. Lower-income countries that cannot afford expensive lockdowns are particularly in need of cheaper interventions, and contact tracing could fill that role only if it is done swiftly enough. We would like to find candidates that are helping lower-income countries deploy early contact tracing. The TCN coalition coordinates organizations working on mobile contact tracing, but we didn't see a specific focus on poorer regions without Apple/Android phones. Partners in Health has launched a major contact tracing initiative, but for now it is primarily focused on the United States.
• Supporting health systems and cash transfers in neglected regions, particularly Latin America. This may partially reflect our existing networks and knowledge base, but have been able to find many more promising options focused on beneficiaries in Africa and India than in other parts of the Global South. Most interventions in Southeast Asia appear to be country-specific rather than region-wide, and many large international relief NGOs appear to have limited presence in Central and South America, an area of the world that is currently experiencing a rapid increase in cases. We would be particularly interested to find organizations offering cash transfers in these regions.

V. Addendum: Should you prioritize COVID response over other EA priorities?

We've written this post primarily for the benefit of donors who have already decided to focus on COVID-19 for their own reasons. We have not made it a priority to analyze the relative value of COVID-related donations as compared to other issues or causes. This post should not be seen as taking any position for/against prioritizing COVID-19 over other issues or causes.

That said, we know this question is top of mind for many EAs, and we wanted to offer some brief thoughts on it here.

Evaluating the relative cost-effectiveness of "COVID-themed" vs. "non-COVID-themed" donations is more difficult than if these were wholly separable topics/areas. Instead, the effects of the pandemic itself are intertwined with both donors' actions and the work of the organizations they support in several ways. (This intertwinement seems less pronounced for cause areas such as AI x-risk, and more pronounced for cause areas such as global health and pandemic preparedness).

Some of these entwined interactions point against prioritizing COVID:

• Donors and other funders are facing immense pressure to step up their giving and direct attention towards this pandemic. As a result, anti-malaria and other global health interventions will likely be even more underfunded than usual as a result, not only today but potentially for several years.

Some interactions point in favor of prioritizing COVID:

• The tremendous global disruption set in motion by the pandemic could be harmful to other work that EAs consider important (for example, supply chain disruptions may disrupt access to malaria control tools), such that working to resolve the root cause of the disruption may be one of the most effective ways to allow the most important work to get back on track.
• See GiveWell blog post "The impact of COVID-19 on GiveWell’s plans" for more on impacts and disruptions.
• An improved response to this crisis may translate into better preparedness for future pandemics.
• GiveWell donors motivated by the promise of guaranteed impact from intensely vetted, cost-effective charities must accept that the current environment marks a significant departure from the conditions under which those interventions were shown to work well.
• Note that in GiveWell's EA Forum post on April 23 about COVID-19 grants, they recommend that individual donors still give to the normal recommended charities.

These factors point to a complicated picture that we have not undertaken to disentangle here. Overall, while we do not suggest that EAs redirect their giving away from effective charities they already support, especially in the global health arena, we do feel there are strong reasons for EAs to consider additional, COVID-specific giving. Moreover, the situation is so quickly evolving that there is not yet an established consensus about what is most effective to do, so we believe it is important that individual EAs take up the mantle of thinking carefully about what they think is best to do in the current unusual times, rather than exclusively deferring to the opinion of trusted voices in the EA world.

(For another EA Forum post which has a different take, see COVID-19 response as XRisk intervention)

Previous update log

June 22:

• Added Protege BR as a top recommendation.
• Added 1 Day Sooner as a promising opportunity.
• We are seeking additional recommendations for charities that operate in Latin America and the Arabian Peninsula, particularly in the areas of direct aid (cash transfers) and strengthening health systems.

May 22:

• Added COVID-END and Open Source Medical Supplies as top recommendations.
• Added Development Media International (previously listed as Top), IDinsight, Rapid Reviews COVID-19, and the COVID-19 Early Treatment Fund as promising opportunities.
• Wrote up reviews for above charities plus Medical Credit Fund, ONE Campaign, Oxfam, Population Services International, and Give2Asia in our full database of opportunities.