I’m not sure when a person can officially be called a philanthropist. If there’s a specific amount of money someone has to give or a track record of years consistently donating, I’m not aware of it. But if we define a philanthropist as someone who loves humankind, as its etymology suggests, then sign me up!
I’ve been actively involved in the effective altruism community for over ten years now, and while my relationship with EA has changed over the years, my commitment to donating a portion of my income each year to charities working in public health has not. I don’t do this out of a sense of moral obligation (anymore) - I do this because I love humankind.
For over a decade, I’ve donated to charities that have been recommended by GiveWell, a charity evaluator that conducts thousands of hours of research into the organizations that they believe could do huge amounts of good through the donations they receive. The reasons I donate to GiveWell will be familiar to anyone who’s heard of effective altruism before: the GiveWell team is thorough, impact-driven, and they believe that they can help find the charities that can do the most good for the most people to the greatest degree possible with the highest degree of confidence (this, by the way, is the most succinct definition of EA that I’ve heard over the years, and it’s from Steve Thompson, the co-founder of Charity Entrepreneurship).
This year, however, a new giving opportunity that wasn’t listed on GiveWell presented itself to me: a new initiative called Spiro.
Spiro is a charity that is working to expand access and improve efficiency of diagnostics and treatment for people who are at high risk of contracting tuberculosis, especially children.
Tuberculosis kills 1,300,000 people every year, a disproportionate amount of whom are children. It is currently the most prevalent lethal infectious disease in the world, surpassing deaths caused by Malaria and HIV. I had originally heard about TB’s staggering impact on humanity from the semi-niche YouTube channel called Vlogbrothers. I’ve been following the brothers Green for even longer than I’ve been in the EA community (I first subscribed in 2011 - DFTBA!), and I love how they’ve matured from a quirky duo making videos about pregnant goats to a pair of thoughtful community leaders and innovators in online education, meaning-making in modern times, and public health. When John Green started creating videos about TB, I started doing my own research into just how terrible the burden of this disease truly is in our world, and I was horrified by what I learned.
Then, in November of last year, I got an email from Habiba Banu telling me about how she was teaming up with Roxanne Heston to form Spiro and tackling this massive global health challenge.
Now, I wouldn’t say that Habiba and I are friends (yet!), but I was familiar with her past work and writing/coaching with 80,000 Hours, and I’d also seen her speak at EAG, so I had admired her from afar. Same story with Roxanne: I knew of her past work in the policy space and I knew that she was clearly very talented and capable. (This highlights one of the main benefits of being involved in the EA community, namely that you get to meet amazing people who are passionate about improving the world and have spent their careers committing themselves to noble causes.) I trust Habiba and Roxanne to work on something important, and I know they wouldn’t have founded Spiro if they didn’t think they could spend their time in this field effectively. I was excited to support them and help in the fight against TB, which is why I donated a significant portion of my 2023 giving to Spiro.
In many ways, this year’s donation to Spiro is a complete reversal of the motivations that have typically guided my giving in the past.
If you’ve ever met me or heard me speak, you’ll know that my main crusade in public health has historically been malaria. I’ve been following the progress of malaria elimination efforts for years, I know a ton about the plasmodium that causes malaria, and between my own personal donations and pubic fundraisers I’ve held in the past, I’ve given the Against Malaria Foundation nearly $200,000 dollars over the past decade. That’s roughly 80,000 mosquito nets, with each net making the world a little safer from the disease.
Tuberculosis, on the other hand, is a whole new beast for me. I’ve been learning a lot about the (surprisingly complex) biology of the disease and how it spreads, but there’s still so much I don’t know. TB is tricky for a lot of reasons, and scientists are still figuring out why some people are resistant to certain strains of TB and not others. One thing that seems to be a consensus in the TB world, however, is that screening and preventative treatment is a major bottleneck to efficiently reducing the burden of TB. That’s why when Habiba and Roxanne announced that their new initiative would focus on identifying at-risk populations and delivering preventative treatment, I was excited to find out more and support their work. If they’re innovating in the space, there might be lots of unexplored territory in the domain of screening, and so one or two good ideas could really move the needle and get more treatments to more people.
This leads into the second reason why this year’s donations were dramatically different compared to previous years for me: Spiro is an untested charity. In the past, I’ve donated to initiatives with long established track records with lots of evidence and field studies and randomized control trials to prove their efficacy. EAs generally place a high value on certainty and confidence, so an intervention with more confidence will almost always win out when compared to an intervention with less data to support whether it works. I also prize confidence very highly, but while confidence is important when evaluating charities, it can be trumped by a high expected value calculation. Though Spiro might be untested, its positive effects in the world could be vastly greater than the work being done by the Against Malaria Foundation (on a dollar for dollar comparison). For example, if we suppose that a life could be saved with a $500 donation to Spiro at 50% confidence while GiveWell estimates that it would cost $5,000 to save a life with the AMF at 100% confidence, then Spiro has a 5x greater expected value than the AMF. High risk, high reward. If it turns out to be true that Spiro can reliably identify people who are at risk of contracting TB and administer life-saving preventative treatment, then their intervention might reasonably be more cost-effective than donating to provide mosquito nets for those at risk of contracting malaria. This seems not only plausible to me, but likely, and that’s why I donated to Spiro this year.
Finally, the third way in which this year’s donations differ from previous years is because of the level of faith I’m placing in individuals. Habiba and Roxanne are exceptional people - they’ve proven themselves to be dedicated, diligent, and daring in a field that desperately needs more people like them. I don’t know for sure that they can deliver, but I have faith that they can.
Effective altruism tends to value quantifiable metrics and hard data, but sometimes there are moments when it makes more sense to lead with hope, trust, and faith.
I have faith in Habiba and Rox, I have faith that we can and will end the fight against tuberculosis, and I have faith in the love of humankind.
I hope you’ll join me and consider donating to Spiro at https://www.spiro.ngo/