EA - The Case for Funding New Long-Term Randomized Controlled Trials of Deworming by MHR

Link to original articleWelcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: The Case for Funding New Long-Term Randomized Controlled Trials of Deworming, published by MHR on August 4, 2022 on The Effective Altruism Forum. Summary Despite significant uncertainty in the cost-effectiveness of mass deworming, GiveWell has directed over a hundred million dollars in donations to deworming initiatives since 2011. Almost all the data underlying GiveWell’s cost-effectiveness estimate comes from a single 1998 randomized trial of deworming in 75 Kenyan schools. Errors in GiveWell’s estimate of cost-effectiveness (in either direction) could be driving an impactful misallocation of funding in the global health and development space, reducing the total welfare created by Effective Altruism (EA)-linked donations. A randomized controlled trial replicating the 1998 Kenya deworming trial could provide a substantial improvement in the accuracy of cost-effectiveness estimates, with a simplified model indicating the expected value of such a trial is in the millions of dollars per year. Therefore, EA-aligned donors may have made an error by not performing replication studies on the long-run economic impact of deworming and should prioritize running them in the future. More generally, this finding suggests that EA organizations may be undervaluing the information that could be gained from running experiments to replicate existing published results. Introduction Chronic parasitic infections are common in many regions of the world, including sub-Saharan Africa and parts of East Asia. Two common types of parasitic disease are schistosomiasis, which is transmitted by contaminated water, and the soil-transmitted helminth infections (STHs) trichuriasis, ascariasis, and hookworm. Mass deworming is the process of treating these diseases in areas of high prevalence by administering antiparasitic medications to large groups of people without first testing each individual for infection. The antiparasitic medications involved, praziquantel for schistosomiasis and albendazole for STHs, are cheap, have relatively few side effects, and are considered safe to administer on a large scale. There is strong evidence that deworming campaigns reduce the prevalence of parasitic disease, as well as weaker evidence that deworming campaigns improve broader life outcomes. GiveWell has included charities working on deworming in its top charities list for over a decade, with the SCI Foundation (formerly the Schistosomiasis Control Initiative) and Evidence Action’s Deworm the World Initiative being the top recipients of GiveWell-directed deworming donations. As of 2020, GiveWell has directed $163 million to charities working on deworming, with this funding coming from individual donors giving to deworming organizations based on GiveWell’s recommendation, GiveWell funding deworming organizations directly via its Maximum Impact Fund, and Open Philanthropy donating to deworming organizations based on GiveWell’s research. GiveWell’s recommendation of deworming-focused charities is based almost entirely on the limited evidence linking deworming to long-term economic benefits, particularly increases in income and consumption. Regarding impacts on health, the GiveWell brief on deworming states “evidence for the impact of deworming on short-term general health is thin. We would guess that deworming has small impacts on weight, but the evidence for its impact on other health outcomes is weak.” So-called “supplemental factors” other than the effect on income change GiveWell’s overall cost-effectiveness estimate for Deworm the World by 7%. GiveWell’s estimate of the long-term economic benefit produced by deworming comes from “Twenty-Year Economic Impacts of Deworming” (2021), by Joan Hamory, Edward Miguel, Michael Walker, Michael Kremer, and Sarah Baird. This paper is a 20-year follow-up to “Worms: Ident...