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Re: [givewell] More success stories, from Sachs

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  • Holden Karnofsky
    I typed everything Sachs says that s of interest. He only has a paragraph on each success story, and no references.
    Message 1 of 3 , Jan 22, 2009
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      I typed everything Sachs says that's of interest.  He only has a paragraph on each success story, and no references.

      On Thu, Jan 22, 2009 at 5:08 PM, Elie Hassenfeld <ehassenfeld@...> wrote:

      Re: success of GAVI. Does Sachs mention a change in mortality rates/incidence from the diseases for which GAVI has successfully vaccinated people? GAVI's been around since 2000, so I'd expect that any significant increase in vaccination coverage would lead to improved outcomes re incidence and mortality.

      The three vaccines mentioned here are Hib, Hep B, and yellow fever, so I looked at those. The latest immunization monitoring report from the WHO (2007) is available at http://whqlibdoc.who.int/hq/2007/WHO_IVB_2007_eng.pdf (6mb PDF).

      Vaccine coverage rates are up.

      • Hep B (3rd dose = full immunization) - 32% -> 60%, Pg 12
      • Hib - 14% -> 22%, Pg 14
      • Yellow fever - 35% -> 73%, Pgs 26-7.
      What about incidence?

      For yellow fever, the report also provides incidence. Since 1999, annual incidence is as follows (no clear positive trend):

      '99 - 214
      '00 - 684
      '01 - 620
      '02 - 705
      '03 - 672
      '04 -1'344
      '05 - 588
      '06 - 356

      (The report doesn't note whether these are in '000s. I'm guessing they are because Pg 26 says that WHO estimated 30k deaths from yellow fever in 2002.)

      I don't know why the WHO only presents incidence for yellow fever and not Hib or Hep B, but the disconnect between the strong increase in vaccination coverage but no decrease in incidence (the 356 in '06 oculd be somethign real, or could be noise) makes me wonder what's going on.

      What about data accuracy?

      There's some possibility that the GAVI/WHO focus on immunuzation rates led to heavier monitoring, leading to a measured *increase* in incidence. Incidence in the Africa region since 1997 is:

      '97 - 47 
      '98 - 33
      '99 - 8
      '00 - 593
      '01 - 572
      '02 - 610
      '03 - 498
      '04 - 1'253
      '05 - 474
      '06 - 272

      The report states, "In 2004 the Democratic Republic of the Congo reported 1'192 cases, however no case was confirmed in the laboratory." I have no idea what to make of this other than that I find it hard to have confidence in the accuracy of this data.

      I'd like to do more systematically look at changes in vaccination coverage rates and incidence/mortality rates for the associated diseases, but what I've seen here makes me wonder whether the data is accurate enough for that excercise to be worthwhile.

      On Thu, Jan 22, 2009 at 4:09 PM, Holden Karnofsky <Holden@...> wrote:

      I'm taking a closer look at Jeffrey Sachs's book (before I did a 30-min scan in the bookstore; now I actually have a copy).  On pgs 260-265 he lists "several significant examples of programs that have been scaled up massively to remarkable success."

      So far our only source for major/macro "success stories" has been  the Levine book published by Center for Global Development (discussed earlier: http://groups.yahoo.com/group/givewell/message/25).  Sachs has points of overlap but also adds some.

      Cases where Sachs's characterization matches Levine's:
      • Eradication of smallpox (Levine case study #1)
      • Control of river blindness in sub-Saharan Africa (#7)
      Campaigns that Sachs sees as broader than how Levine presents them:
      • Polio control: Levine case study #5 points to elimination of polio in Latin America & the Caribbean by the Pan American Health Organization; Sachs credits the Global Polio Eradication Initiative and says "Today, thanks to massive efforts by official institutions such as WHO, UNICEF, and the U.S. Centers for Disease Control and Prevention, as well as actions within poor countries and a remarkable and tireless effort by Rotary International, polio remains in only six countries ... Only 784 cases were reported worldwide in 2003, compared with 350,000 in 1988."
      • Family planning: Levine case study #13 discusses a fertility reduction program in Bangladesh, but Sachs says "Modern contraception ha contributed to a dramatic reduction in total fertility rates, from a world average of 5.0 children per woman in the period 1950 to 1955 to 2.8 children per woman in the period 1995 to 2000 ... The United Nations Population Fund (UNFPA) ... has helped to spur a massive increase in the use of modern contraception among couples in developnig countries, rising from an estimated 10 to 15 percent of couples in 1970 to an estimated 60 percent in 2000"
      More success stories from Sachs:

      • Global Alliances for Vaccines and Immunization (GAVI): "As of 2004, the alliance reported 41.6 million children vaccinated against hepatitis B; 5.6 million children vaccinated against ... Hib; 3.2 million children vaccinated against yellow fever; and 9.6 million children vaccinated with other basic vaccines."  As we've noted before, we are suspicious of these #'s until we get a better sense of GAVI's data quality audit process.  The #'s are reported by governments that receive direct funding from GAVI.
      • Campaign for Child Survival, launched in 1982 by UNICEF: "The campaign promoted a package of interventions known as GOBI: growth monitoring of children; oral rehydration therapy to treat bouts of diarrhea; breastfeeding for nutrition and immunity to diseases in infancy; and immunization against six childhood killers ... Child mortality rates fell sharply in all parts of the low-income world, including Africa ... The Campaign was estimated to have saved around twelve million lives by the end of the decade."
      • WHO campaign against malaria in 1950s and 1960s: "Sometimes judged to have been a failure, since malaria was certainly not eradicated, these efforts can be seen as a stunning success for certain parts of the world ... Well over half o the world's population living in endemic regions in teh 1940s were largely freed of malaria transmission and mortality as a result of WHO's concentrated efforts, mainly in the areas where disease ecology favored the control measures.  Africa, alas, was neither part of the program at the time, nor a beneficiary of its results until today."  This program depended on DDT and other pesticides, and chloroquine and other antimalarials (both of which the disease has more recently developed some resistance to).

      Less relevant success stories:
      • Green Revolution - discussed previously
      • Export Processing Zones in East Asia - purely a policy matter (setting up zones where "special tax, administrative, and infrastructure conditions are applied in order to encourage foreign companies to set up export-oriented manufacturing facilities"
      • Cellphones in Bangladesh - "Grameen Telecom went into the business of mobile phones in 1997, reaching half a million subscribers by 2003, roughly equal to the total number of landlines.  It used that mainly urban base of operations to launch a village phones program ... With 9400 villages covered by early 2004, the estimated access would be on the order of 23 million villagers."  No discussion of impact on life outcome / standard of living (and we've previously looked for and failed to find such discussion for the same program).

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