GiveWell Conversations

Clubfoot, a congenital condition where children are born with one or both feet twisted inward, affects roughly one in 800 newborns globally. Most of those cases are in low- and middle-income countries, where only about 20% of children with clubfoot receive treatment. 

While most donations to GiveWell are directed to programs that reduce child mortality, our growing research capacity over the last several years has expanded what we’re able to evaluate and fund. One outcome of that work is that we’re better able to direct donations to highly cost-effective programs addressing disabling conditions, like clubfoot, and meaningfully improve quality of life.    

In this episode, GiveWell CEO and co-founder Elie Hassenfeld speaks with Program Officer Meika Ball about GiveWell’s grant to MiracleFeet, an organization that expands access to clubfoot treatment. Their conversation walks through MiracleFeet’s program, how we estimated its cost-effectiveness, and Meika’s recent site visit to see the program in action in Côte d’Ivoire.

Elie and Meika discuss:

• How MiracleFeet supports clubfoot treatment: Clubfoot is treated using the Ponseti method, which involves casts to correct the foot’s position, a small surgical procedure, and a period of bracing. MiracleFeet supports this treatment by partnering with local health facilities, training healthcare workers, educating local communities about clubfoot, providing treatment materials, and working with Ministries of Health. Because of this support, treatment is provided at no cost to patients or their caregivers. GiveWell-funded independent surveys in Côte d’Ivoire and Chad indicated that very few children with clubfoot were being treated before the program, and hundreds have been enrolled since the program’s launch.
• What we learned from a recent site visit: Two GiveWell staff members recently traveled to Côte d’Ivoire to visit health facilities and see children being treated through MiracleFeet’s program. We spoke with a range of stakeholders, including healthcare workers, implementing partners, representatives from the Ministry of Health, caregivers of children receiving treatment, and disability advocates. Seeing the program in action increased our confidence that it is leading more children with clubfoot to receive treatment and is having an important impact on their lives. We also saw early signs of the program being integrated into national health systems, such as clubfoot being added to a maternal child health booklet that parents and midwives review after a child is born. 
• What makes this grant different: Most of GiveWell’s grantmaking focuses on preventing child deaths from widespread conditions like malaria or diarrhea. Clubfoot is a relatively rare condition that causes disability, not death. The treatment costs more per child than many other programs we fund, such as distributing vitamin A supplements or malaria nets, and requires sustained caregiver adherence over several years. To assess this grant opportunity, GiveWell applied moral weights, or subjective valuations, for the impact of clubfoot so it could be compared with other programs’ outcomes. We also made a separate grant to support monitoring and evaluation of the program to assess how much MiracleFeet’s support increases the number of children receiving appropriate and effective treatment. 

Our ability to evaluate, fund, and monitor a program like MiracleFeet’s is possible because of years of investment in our research team. This program exemplifies how our growing capacity is enabling us to expand our search for cost-effective opportunities where donors can do exceptional good.

Visit our All Grants Fund page to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on March 30, 2026 and represents our best understanding at that time.

Vitamin A supplementation is one of the programs GiveWell has supported the longest, and we’re currently funding it in many African countries. The program has an unusually strong evidence base for reducing child mortality, with multiple randomized controlled trials. Yet, as is the case for most global health programs, the evidence for vitamin A supplementation has complex, unresolved questions, such as how well findings from decades-old trials apply today and the extent to which existing research has been influenced by publication bias. As GiveWell’s research team has grown over the last several years, we have expanded our capacity to carefully research these questions. 

In this episode, GiveWell CEO and co-founder Elie Hassenfeld speaks with Senior Researcher Stephan Guyenet about the evidence base for vitamin A supplementation, the complications in applying that evidence to our funding decisions, and how GiveWell has improved our cost-effectiveness estimates for the program.

Elie and Stephan discuss:

• The evidence base for vitamin A supplementation: Evidence from rigorous trials shows that vitamin A supplementation can significantly reduce child mortality. However, most of these trials were conducted 30 to 40 years ago, when infectious disease rates and vitamin A deficiency were more prevalent, and a more recent large trial in India found a much smaller effect. As a result, we worked to resolve our uncertainties about the effect of vitamin A supplementation in the contexts where we’re supporting it today. 
• How GiveWell worked through the complications: To address our questions about the existing evidence, we engaged in further research. This included an analysis focused on the specific diseases for which vitamin A supplementation reduces mortality, a novel dosing-frequency analysis conducted in consultation with an outside statistician, and an assessment of possible publication bias. 
• What all of this means for grantmaking: While the trials report that vitamin A supplementation reduces the risk of death by 19% on average in children 6 to 59 months old, we estimate that the impact in the modern settings we model is smaller: a 1% to 11% lower risk of death. Nevertheless, we still think vitamin A supplementation can be highly cost-effective. Using our updated cost-effectiveness analysis, we estimate our most recent grant for vitamin A supplementation to Helen Keller Intl is 25 times more cost-effective than our benchmark. This change reflects our more precise, location-specific analyses that allows us to direct funding to places where vitamin A supplementation is likely to be the most cost-effective. 

GiveWell continues to scrutinize the programs we fund, including those we have supported for years. In this case, years of rigorous research have largely held up the case for vitamin A supplementation. We will continue to review the program, funding new research to address remaining uncertainties and exploring whether a new randomized trial might be feasible. By doing so, we’ll continue to increase our confidence and refine our funding decisions to target the most cost-effective locations and do the most good we can with donors’ funds.

Visit our All Grants Fund page to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on March 25, 2026 and represents our best understanding at that time.

GiveWell’s primary focus has always been researching, identifying, and directing donations to programs we believe will do the most good. When GiveWell first started, we approached this by looking for organizations that were already delivering highly cost-effective, evidence-backed programs and directing funding to those programs. Over time, we were able to focus further upstream by first identifying highly cost-effective programs and then supporting the development of organizations to deliver them. 

We’ve been able to take an even more expansive view as our research team doubled in size over the last several years. In addition to our core grantmaking, we’re now funding an increased number of grants designed to provide information that we think will help us direct more funding to highly cost-effective programs in the future. This includes things like generating research about program effectiveness, scoping new promising programs, and piloting program variations.  

GiveWell has long made some grants aimed at improving our knowledge base, but this work has now grown substantially and become more systematic. In 2025, GiveWell made 18 grants, totaling approximately $39 million, that were aimed specifically at getting more information to improve future funding decisions. In our latest podcast episode, GiveWell CEO and co-founder Elie Hassenfeld speaks with Program Director Julie Faller about these “value of information” grants.

Elie and Julie discuss:

• Testing variations on cash transfers to improve cost-effectiveness: Following an initial scoping grant, GiveWell recently funded GiveDirectly to pilot three program variations aimed at increasing the economic impact of its flagship program, which provides unconditional cash transfers to very poor households. Each pilot tests a different approach to increasing impact: one provides grants to local businesses ahead of a cash transfer rollout, another targets transfers to the poorest young adults, and the third pairs transfers with footbridge construction to help remote communities access markets and services. Through these pilots, we expect to learn more about the feasibility and potential cost-effectiveness of the program variations, potentially leading to opportunities to help people in need even more.  
• Testing a delivery model for diarrhea treatment: Oral rehydration solution—an inexpensive, effective treatment for diarrhea-related dehydration—is used by far fewer children than could benefit from it. To explore whether door-to-door delivery could increase uptake, GiveWell funded a large randomized controlled trial with the Clinton Health Access Initiative in Bauchi, Nigeria. Initial results are promising, indicating that 3,000 community distributors were able to reach about 80% of households with young children—and that ORS usage increased as a result. GiveWell is now considering whether to fund this model at scale, potentially with multiple implementers.
• Collecting better data on a nutrition program in India: GiveWell has supported Fortify Health, which works to address widespread anemia in India by partnering with flour millers to fortify wheat flour with iron. GiveWell recently funded a household survey in six Indian cities to better understand how much fortified flour people are actually consuming, and who in the household is eating it. The survey provided more information about several parameters that, taken together, allowed us to resolve some uncertainty about the program’s cost-effectiveness. We used what we learned to inform our decision to renew funding for the program.  

These examples reflect a longer-term shift at GiveWell—from an organization that primarily evaluated existing programs to one that increasingly generates the evidence needed to improve its grantmaking and fund more impactful programs in the future.

Visit our All Grants Fund page to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on March 13, 2026 and represents our best understanding at that time.

GiveWell aims to find and fund programs that will do the most good per dollar. To do this, we carefully evaluate potential grants before making them—assessing academic evidence, building cost-effectiveness models, and talking to people in the sector who know the program well. 

But our work doesn’t stop there. When a program we’ve supported nears the end of their funding, we also regularly evaluate its results to decide whether to continue our support. This typically involves gathering and analyzing extensive monitoring data. In most cases, the results are consistent with what we expected, and we renew the programs’ support. But sometimes we decide that, even if a program is doing a lot of good, it may not be having the impact we expected. In that case, we decide not to renew our support and instead direct those funds to where we think they’ll do much more good for people in need. 

In this episode, GiveWell CEO and co-founder Elie Hassenfeld speaks with Senior Program Officer Erin Crossett about the research that led GiveWell not to renew support for Evidence Action’s Dispensers for Safe Water—a program that installs chlorine dispensers at rural water points so that households can treat their drinking water and reduce waterborne disease—in Malawi and Uganda.

Elie and Erin discuss:

• How independent data revealed a significant gap in program reach: Early signals from a separate GiveWell-funded study and Evidence Action’s own internal review of the program in Kenya suggested chlorination rates were far lower than routine monitoring indicated. GiveWell then commissioned an independent survey in Uganda and Malawi to find out whether the same was true there. The survey found that only about a third as many people were using dispensers as previously estimated: roughly 2 million rather than 5 million. 
• Potential reasons for the data discrepancy: We believe that no single error drove the discrepancy. Instead, there were five or six contributing issues that together caused the differences in estimated usage. For example, chlorine was measured by matching a test result to a color wheel, which can be subjective and affected by lighting. This data was collected by Evidence Action’s own staff, which may have led them to interpret the color wheel results more favorably. 
• What GiveWell learned and its effect on future grantmaking: We believe that approving the initial grant in 2022 was the right decision, given what we knew at the time. We also think that we could have done better by, for example, investing earlier in independent verification. We now apply these lessons to our current grantmaking. For instance, our recent portfolio of safe water grants includes external surveys for all grants. 

As we've developed and grown our research team over the past several years, we’ve become increasingly able to support additional data collection, analyze and learn from our grants, and reallocate resources to the most cost-effective global health and development needs we find. 

Getting things right requires both honest self-assessment and grantee partners willing to open themselves to scrutiny, and we are grateful for Evidence Action’s partnership in identifying the discrepancy in usage rates. Evidence Action is now reducing its footprint in Uganda and Kenya, and winding down the program in Malawi, with a 24-month transition to help support communities and turn over operations to the governments where possible. 

Dispensers for Safe Water is still a program that helps people, and our grant provided clean water to millions. GiveWell’s decision not to renew reflects our mission to direct donor funds to where they will do the most good—not to fund everything that does good. We are continuing to support chlorine dispensers in contexts where we believe they will be highly cost-effective. For instance, we are currently considering a grant to Evidence Action to pilot variations of the program in northern Nigeria, where disease burden is much higher than the countries where we had been funding the program—and therefore the impact per dollar might pass our high bar for funding. 

Visit our All Grants Fund page to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on February 20, 2026 and represents our best understanding at that time.

Vaccines are remarkably effective at preventing deadly diseases, and, while global needs for them are great, vaccines already receive substantial global funding. This creates a challenge: How do you identify opportunities where additional funding can meaningfully increase vaccination rates and save lives?

GiveWell has long recognized the potential for highly cost-effective vaccine programs. We started supporting vaccination programs in 2015 and have made over $200 million in vaccination-related grants to date. For example, New Incentives, one of our Top Charities, aims to increase routine childhood vaccinations in northern Nigeria by providing small cash incentives to caregivers who bring their children into clinics for vaccinations. 

Over the past several years, we’ve been growing our research team and laying the groundwork to expand the scope of our work and funding. 

In this episode, GiveWell CEO and co-founder Elie Hassenfeld speaks with Senior Program Officer Natalie Crispin, who leads GiveWell’s vaccination grantmaking. They discuss how our research approach has evolved and what it means for helping more children access life-saving vaccinations.

Elie and Natalie discuss:

• Moving from finding existing programs to targeting funding gaps: In the past, GiveWell primarily looked for specific, evidence-backed program types to support—such as conditional cash transfers that incentivize vaccination. Now, with a dedicated vaccines team, we ask a bigger question: What are the bottlenecks that prevent children from getting vaccinated and how can we address them? This shift has driven our funding in areas like vaccination outreach, where teams travel to remote communities to deliver vaccines.
• Building a grantmaking portfolio to maximize learning: GiveWell recently funded several vaccination outreach programs. For example, in DRC’s Kongo Central province, where vaccination coverage rates are low, we’re supporting planning vaccination sessions (e.g. timing, frequency, location) with better data, paying community health workers to track which children need vaccines, and funding motorbikes and fuel for vaccination teams to provide vaccination near communities who are far from health facilities. This year, we hope to fund a number of additional vaccination outreach and mobile vaccination programs in differing contexts. We expect this will provide the opportunity to learn quickly about what works and help us direct future funding accordingly.
• Expanding capacity through specialization: Over the past three years, GiveWell’s research team has doubled in size and its structure has changed. Today, nearly 60 researchers work on cause-specific teams, one of which focuses on vaccination. This specialization has enabled deeper relationships with vaccination implementers, funders, and government officials—relationships that have allowed us to surface new opportunities and better understand potential funding gaps. 

GiveWell’s vaccination grantmaking is a longstanding area of focus with growing diversity and impact. The deepening expertise and novel approaches of that dedicated team illustrate how the research team as a whole has evolved to pursue opportunities we wouldn’t have been able to just a few years ago. With greater capacity and specialization across health areas, we’re now better positioned to identify and direct donations to highly cost-effective programs that save and improve lives.

Visit our Top Charities Fund and All Grants Fund pages to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on February 10, 2026 and represents our best understanding at that time.

Seasonal malaria chemoprevention (SMC)—a program that provides preventive antimalarial medication to young children during the months when malaria is mostly likely to be transmitted—is one of the most cost-effective programs GiveWell has identified. Malaria Consortium’s SMC program has been one of our Top Charities since 2016, and we’ve recommended more than $500 million in grants to the program.

Most of our funding to date has supported programs in West Africa, where strong evidence gives us confidence in the effectiveness of the drug combination used. In eastern and southern Africa, malaria chemoprevention programs could potentially help many more children, but we have substantial uncertainties about drug effectiveness in that region.

In this episode, GiveWell CEO and co-founder Elie Hassenfeld speaks with Senior Researcher John Macke about the CHAMP trial, a randomized controlled trial of chemoprevention drugs we’re supporting in Malawi, and how it could shape our malaria grantmaking.

This research is one example of how GiveWell is building for the future: investing in research now that could substantially expand our ability to direct funding cost-effectively in the years ahead.

Elie and John discuss:

• Why eastern and southern Africa present different challenges: One of the drugs used in seasonal chemoprevention shows widespread resistance in the region, and existing trial evidence about the effectiveness of chemoprevention there has limitations. While we’ve supported SMC in parts of Uganda and Mozambique, we’ve been cautious about scaling up without stronger evidence on which drug combinations work and whether using certain drugs could increase resistance.
• What this trial will tell us: The trial will test three drugs alone and in different combinations across roughly 7,000 children in Malawi, making it the largest individually randomized trial of chemoprevention drugs ever conducted. We’ll learn about the efficacy of the two drugs currently used in SMC, as well as an additional drug that had previously shown resistance but might now be effective again. The trial will look at the effect of the drugs on both malaria infections and hospitalizations caused by malaria.
• How the results could affect our grantmaking: Depending on what we learn, this trial could open up more than $100 million in cost-effective funding opportunities for chemoprevention programs each year in eastern and southern Africa. The trial results will also provide a knowledge base for other funders and implementers to improve the cost-effectiveness of malaria programming. We expect initial results in mid- to late 2027, with the potential for resulting grants to provide medication to children in 2028-2029.

Visit our Top Charities Fund and All Grants Fund pages to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on January 22, 2026 and represents our best understanding at that time.

GiveWell is often thought of for its Top Charities, but over the last several years, we’ve been substantially broadening our work. We’ve developed new ways to identify potential grantees, funded research to fill gaps in our understanding, and explored new program areas where we believe cost-effective opportunities exist but other funders aren’t investing. This increased breadth isn’t a goal in itself—we’ve been laying the groundwork to deliver more impact, now and in the future.

In this episode GiveWell CEO and co-founder Elie Hassenfeld speaks with Senior Program Officer Julie Faller about how our research approach has evolved and what it means for the future of our grantmaking.

Elie and Julie discuss:

• Launching new approaches for finding grantees: In the past, we primarily found grantees through our existing networks. We’ve recently started running requests for proposals for programs like in-line chlorination (a water treatment program) and vaccine outreach, which has allowed us to learn about and fund organizations we hadn’t previously worked with. As our research team has grown, we’ve gained expertise and the ability to articulate a clearer perspective on the kinds of programs we believe are likely to be cost-effective.
• Using a grant portfolio approach to learn more: From the hundreds of proposals we received for in-line chlorination pilot programs, we funded a portfolio of pilots across a number of African countries. Because we funded a wide range of organizations working in varying contexts with diverse program models, we’ll learn a lot very quickly and be able to apply those lessons to future funding decisions. We’re incorporating intensive monitoring and evaluation, as well as technical assistance to increase the likelihood that the pilots succeed and to maximize what we learn.  
• Broadening our research funding: While GiveWell has funded research for many years, we’re now taking a broader view of the research questions and research designs we might support. For example, we recently funded a study to better understand how hemoglobin levels among anemic individuals are associated with particular health outcomes, which could improve global anemia guidelines and our funding decisions for iron fortification and supplementation programs.

This work reflects some of the outcomes of a shift several years in the making. By strategically growing and diversifying our research team, we’re building the capabilities needed to direct more donations to highly cost-effective programs and help more people in need. 

Visit our All Grants Fund page to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on January 13, 2026 and represents our best understanding at that time.

GiveWell has built its reputation on rigorous research—analyzing randomized controlled trials, building cost-effectiveness models, and reviewing monitoring data to identify cost‑effective ways to save and improve lives.

In an effort to supplement this desk research and make better decisions, we’ve been working to gather more information directly from the people who live and work in the countries where we fund programs.

In this episode, GiveWell CEO and co-founder Elie Hassenfeld speaks with Principal Researcher Alex Cohen about GiveWell’s work to gather local insights to check our assumptions and figure out what we might be missing.

Elie and Alex discuss:

• Testing key hypotheses about the data GiveWell relies on: We’re working to improve the inputs in our decision making. This includes checks on coverage data, more information about how programs work in practice, and assessing whether estimated program effects are plausible. These efforts have already identified discrepancies between coverage surveys and other areas for improvement.
• Addressing the limitations of global health data: GiveWell depends on credible data for its research, yet global health and development data is quite limited. For example, basic measurements like child mortality rates rely on household surveys conducted only every five years. We’re employing multiple approaches to address these limits: funding independent survey firms; conducting site visits; hiring local consultants; and strengthening networks with government officials, implementing organizations, and other funders.
• Balancing the trade-offs between local work and desk research: Desk research will continue to make up the vast majority of our work. We believe that complementing that research with additional information we gather from local sources could meaningfully improve our grantmaking. We expect to dedicate around 5% of our research team’s time and around 1% of our total grantmaking to these efforts, which we believe will have an outsized impact.

By prioritizing efforts to learn from people in the places where we fund programs, we hope to better understand how programs are being implemented, identify bottlenecks, and more. We believe that incorporating this information will improve our decision-making and our work to help people as much as we can. It provides checks on our primary models, increases confidence in our conclusions, and could highlight where we might be missing something important.

Visit our All Grants Fund page to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on December 23, 2025 and represents our best understanding at that time.

Global health programs faced major disruptions to their funding in 2025. Back in March, we published our first podcast episode to share a timely snapshot of the immediate impacts caused by the foreign aid freeze and GiveWell’s initial response strategy. It was unclear whether and when funding would resume, and what the medium and long-term implications would be for life-saving programs. 

Over the last year, GiveWell has drawn on almost two decades of cost-effectiveness research and analysis to assess the effects of this tumult in real time, identify gaps where funding could have exceptional impact, and prepare for future needs. We’ve made nearly $50 million in grants in direct response to funding cuts, as part of our expected total grantmaking of around $350 million for the year. 

In our final episode of the year, GiveWell CEO and co-founder Elie Hassenfeld and Director of Research Teryn Maddox follow-up on their first podcast conversation to look back at GiveWell’s response: Where did we succeed? What did we get wrong? Where could we have done better? How did our response evolve? And what might all of this mean for the world and our work in 2026? 

Elie and Teryn discuss:

• Strengthening partnerships for better decision-making: GiveWell first focused on addressing urgent gaps in familiar, high-impact program areas like malaria prevention, where our existing partnerships provided timely information about programs with imminent funding needs. We also built new relationships in areas previously well-funded by the US government, such as HIV prevention and treatment, where we’d done little prior grantmaking.
• The current state of aid and emerging needs in the new year: Some funding was reinstated for certain life-saving areas like malaria prevention, but other areas faced larger cuts and future funding levels remain uncertain. In addition, changes in how aid is structured have created further ongoing uncertainty. We anticipate that needs will continue to emerge in areas like HIV prevention—particularly for key populations that may be deprioritized—even as promising new interventions become available. 
• What we’ve learned and how we’re preparing for 2026: We discuss some of our successes—like funding guarantees that kept malaria prevention campaigns on track—and new modeling approaches we used. We’re drawing on lessons from that work and making learning grants in new areas, including HIV, family planning, and health systems strengthening, to position ourselves for potential future cuts. 

Read our blog post to learn more about our response to this year's aid cuts, visit the All Grants Fund page to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on December 16, 2025 and represents our best understanding at that time.

On Thursday, December 4, 2025, GiveWell hosted a live webinar titled “Growing Needs, Shrinking Aid: Cost-Effective Action in a Year of Funding Cuts.” 

Major cuts to foreign aid this year created deep uncertainty for global health programs. In this live-recorded discussion, co-founder and CEO Elie Hassenfeld moderates a panel of GiveWell researchers to discuss the effects of these cuts and how GiveWell is leveraging its nearly two decades of experience in cost-effectiveness research and analysis to identify opportunities for exceptional donor impact.

The panelists—Rosie Bettle (Program Officer, Malaria), Alex Bowles (Program Officer, Malaria), Meika Ball (Senior Research Associate, New Areas), and Dilhan Perera (Senior Research Associate, New Areas)—answered questions selected live by attendees and shared their insights. They discussed the challenges of understanding the cuts’ impacts, how GiveWell adapted its grantmaking approach to fund time-sensitive opportunities, the trade-offs the research team had to make in the face of uncertainty, and new areas that might have cost-effective funding gaps. 

The conversation explores what the research team has learned so far, along with their predictions and uncertainties about the future. We expect needs to continue growing in the years ahead as the effects of current and future cuts accumulate. In this context of growing need, it’s increasingly important that resources are used as effectively as possible. 

Check out this blog post to learn more about our response to this year’s aid cuts, visit the All Grants Fund page to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on December 4, 2025 and represents our best understanding at that time.