The Simplest Way to Save Lives With Your Money

What It Covers

Ezra Klein interviews Elie Hassenfeld, CEO and co-founder of GiveWell, about evidence-based charitable giving. They discuss how GiveWell evaluates global health charities through rigorous cost-benefit analysis and randomized controlled trials, the organization's top charity recommendations including malaria prevention and vitamin supplementation, and how the Trump administration's foreign aid cuts have created new funding gaps requiring $40 million in emergency philanthropic response.

Key Questions Answered

• •Cost-effectiveness measurement: GiveWell uses a standardized metric comparing programs by cost per death averted, determining that top-recommended charities like Against Malaria Foundation achieve roughly three times more impact per dollar than direct cash transfers through GiveDirectly. This quantitative approach enables donors to maximize lives saved with limited resources, though it requires difficult subjective judgments about weighing health gains against income improvements and other quality-of-life factors across different intervention types.
• •Top charity portfolio: GiveWell's four top charities for 2025 include Against Malaria Foundation for bed net distribution, Malaria Consortium for seasonal chemoprevention medication, Helen Keller International for vitamin A supplementation to children aged six months to five years, and New Incentives for cash incentives encouraging childhood immunizations. These represent the strongest combination of rigorous evidence, proven track record, and transparent data among 70 organizations receiving GiveWell-directed funds totaling over two billion dollars since inception.
• •Measurement failure case study: GiveWell supported No Lean Season, a program providing small cash incentives for Bangladeshi rural workers to migrate seasonally to cities based on positive randomized controlled trial results. When scaled from 2,000 participants to 100,000, the program failed because microfinance loan officers delivering incentives selected people already likely to migrate rather than those needing encouragement. This demonstrates how implementation challenges at scale can undermine interventions with strong initial evidence, requiring ongoing measurement and willingness to shut down ineffective programs.
• •Foreign aid impact assessment: The Trump administration's USAID cuts reduced global health funding by approximately six billion dollars annually, representing a 50 percent decrease from the previous twelve billion dollar budget and eliminating 10 percent of total global health aid worldwide. GiveWell responded by directing 40 million dollars to fill immediate gaps in malaria control, malnutrition treatment, and basic health services. One Malawi hospital administrator described patients lining up for HIV treatment being turned away when staff were sent home the morning cuts took effect.
• •Data infrastructure collapse: The demographic and health surveys funded by USAID for decades provide nationally representative data that governments use for resource allocation decisions like determining school and teacher needs by district. These surveys also enable organizations like GiveWell to make evidence-based funding recommendations. The elimination of this data collection under aid cuts creates cascading problems for both immediate humanitarian response assessment and long-term program evaluation, forcing philanthropies to consider funding basic data infrastructure previously supported by government.
• •Donation allocation strategy: GiveWell offers three giving options with different risk-reward profiles: the top charities fund commits money quickly to four proven organizations, the all grants fund provides flexibility to support 70 organizations including newer programs with higher risk but potentially greater impact, and unrestricted donations allow GiveWell to allocate between operating expenses and grants. Donors giving 10 percent of income to high-impact global health causes while maintaining local charitable commitments can significantly increase total lives saved without requiring extreme personal sacrifice.