Want to help save the most lives possible? Here’s where to give money.

If you want to help human beings alive right now, there are few better places to give than global health.

Diseases that have been largely eradicated in the US still claim hundreds of thousands of lives abroad. In 2018, the most recent year for which there’s data, seven Americans died of malaria; all acquired it abroad. But the World Health Organization estimates that worldwide, 405,000 people died of it that year, most of them children in Africa.

The US and other rich countries have succeeded in stamping out these diseases because eliminating them is fairly cheap. That is an opportunity for people seeking to give and make others’ lives better: It means that saving a life in a relatively poor country is possible at relatively low cost. GiveWell, our favorite evaluator of global health charities, estimates that the groups it recommends can save a life for $3,000 to $5,500. Put another way, giving $250 a month for a year could be enough to save someone’s life. There are gym memberships that cost more than that.

So if you want to donate to global health groups, where should you start? There are too many good causes to list here, but hopefully the ones below give you some ideas.

The two groups take two different approaches to preventing malaria transmission, both of which are extremely cost-effective. Against Malaria focuses on funding and distributing insecticide-treated nets, which people in malarial regions (largely sub-Saharan Africa but also parts of South Asia) can sleep under and protect themselves from bites by malaria-carrying mosquitos.

The nets themselves are incredibly cheap. GiveWell estimates that Against Malaria can provide a net for $4 to $6 each. You may have heard in the news that bednets are sometimes used for other purposes, like fishing. That’s true. GiveWell estimates, based on past studies and their own research, that about 63 percent of nets distributed will be used as intended. But even with nearly two out of five nets being diverted to other uses, the intervention is still incredibly cost-effective. A meta-analysis looking at five randomized studies of bednets found that mortality from any cause fell by 17 percent among children targeted for bednet distribution (whether they used the nets or not); they were 45 percent less likely to get malaria. The effect on children actually using the nets is, of course, much greater.

The other program GiveWell recommends donating to is the Malaria Consortium’s Seasonal Malaria Chemoprevention initiative, which uses another approach to prevent malaria infections. “Chemoprevention” means giving antimalarial medications to at-risk people before they’re bitten by a mosquito, in hopes of preventing a malaria infection. The campaigns are seasonal because in many malarial regions, malaria-carrying mosquitos only thrive and transmit the disease in certain seasons, often during a summer rainy season where there’s more water for mosquitos to breed in.

Seasonal chemoprevention is a newer approach than bednets, but there’s very strong evidence that it’s effective at stopping malaria transmission. GiveWell cites a Cochrane Collaboration review of six randomized studies that found that malaria cases among young children fall by 73 percent due to seasonal chemoprevention campaigns. GiveWell itself extended that review to add two newer studies, and drop an older one that they thought less relevant, and got a similar number: 75 percent less malaria among young children.

A year of chemoprevention costs very little per person, about $5.69 in Burkina Faso, for instance. Combining that low cost with that degree of effectiveness makes it a very inexpensive way to save someone’s life.

It’s pretty easy to get enough vitamin A if you’re in a rich country and can easily access leafy greens like spinach or lettuce, or other vegetables like carrots. But in many poor countries, vitamin A deficiency is a serious problem, which in children can lead to stunting, blindness, or even death.

Thankfully, there’s a simple way to fight vitamin A deficiency: Give people vitamin A. Helen Keller International, a charity founded in 1915 by Keller, the noted deaf-blind writer and activist, is one of the world’s leading groups supporting vitamin A supplementation campaigns, and one of GiveWell’s top recommended charities. It subsidizes governments in affected countries and provides technical support for mass campaigns to distribute vitamin A capsules (about $1 each to deliver) to households with children.

GiveWell recommends Helen Keller because vitamin A supplementation, in their view, significantly reduces child mortality, by about 4 to 12 percent. They base this, as with their malaria judgments, on a Cochrane meta-analysis, which, depending on assumptions used, concluded that vitamin A supplementation reduces mortality by between 12 and 24 percent. That said, the largest study included there produced a much smaller estimate (4 percent), and there’s some reason to believe publication bias has led studies to conclude vitamin A supplementation is more effective at preventing deaths than it really is.

But even 4 percent to 12 percent is a very big drop in mortality. What’s more, vitamin A supplementation has other benefits.

It can prevent blindness and stunting, helping children grow up with healthy vision and to healthy heights and weights, which could translate into higher incomes and other benefits as an adult. Though the evidence here is less voluminous than on mortality, it’s important to remember that there’s more to global health than just preventing deaths. Vitamin A can prevent deaths, but it also makes the lives it saves easier and more fulfilling.

A recent study suggested that in the past fifty years, vaccines have saved 154 million lives, the vast majority of children under 5. Yet vaccine-preventable illnesses like hepatitis A and B or streptococcus pneumoniae still kill millions every year. Expanding access to the vaccines we already have can be as important as developing new ones.

But reaching the so-called last mile of hard-to-reach populations not currently being vaccinated can be difficult. New Incentives, the fourth and final charity recommended by GiveWell, tries a simple method to reach them: offering money. It gives cash incentives of around $9.50 to parents and other adults in northern Nigeria as an incentive to get vaccinated against against measles, pneumococcal disease, tuberculosis, and the five diseases the pentavalent vaccine protects against (diphtheria, tetanus, pertussis, hepatitis B, and Hib).

A randomized trial of New Incentives’s programs released in 2020 found that overall, children targeted by the program were 22 percentage points more likely to be vaccinated: 36 percent of children in the control group were immunized, compared to 58 percent in the group receiving incentives. Even if you suspect the actual impact isn’t quite that significant, the program is extremely cost-effective; GiveWell itself estimates that the effect is more like 9 to 18 percentage points rather than 22, but still ranks New Incentives as one of its top charities.

Empowering and funding local, community-based organizations — as opposed to large, global agencies such as the World Health Organization or the Red Cross — helps create a more nimble, sustainable, and culturally relevant aid environment. Local organizations not only have a better understanding of local needs, but they can respond faster to emergencies.

Funding local organizations is also more cost-efficient because it cuts out the expensive overhead and salary costs that international agencies divert donations to cover. In a recent report based on detailed analyses of aid budgets in Ukraine, Nigeria, and the Middle East, economists estimated that funding local organizations would save almost $30 billion in salaries and overhead currently spent at large international groups. Donor agencies such as the United States Agency for International Development (USAID) and the European Commission have pledged to increase support and funding for local NGOs.

Here are some local NGOs working to address challenges from health care and gender-based violence to unemployment and social development:

Sudan continues to face the most devastating humanitarian crisis in the world. For more than a year, the country has been embroiled in a civil war that has displaced millions of people, pushed some communities to the brink of famine, and crippled the national banking, health care, and telecommunications systems.

And yet, the conflict remains one of the most neglected in the world. As of September, the United Nations has received less than half of the humanitarian funding it requested earlier this year. Meanwhile, staff from international aid and human rights groups have repeatedly faced challenges accessing the most fragile parts of the country while other organizations have been forced to lay off local aid workers due to insecurity and budgetary constraints. These local and international NGOs are still working to fill critical gaps across Sudan and in neighboring countries hosting refugees from Sudan:

Most years, the deadliest infectious disease in the world is tuberculosis, a brutal bacterium that’s also frustratingly expensive to eradicate (which is why none of GiveWell’s top charities target it). But in 2020, 2021, and 2022, there was a new deadliest-disease, and you can probably guess its name: Covid-19.

All told, the Sars-Cov-2 virus has killed over 7 million people, with estimates of “excess deaths” (including deaths due to disruptions to the economy and health care access, and ones due to Covid but not reported as such) reaching into 20 to 30 million. The world spent untold trillions to fight the pandemic. It would have been much more humane, and cheaper, to have prevented it in the first place.

Ultimately, pandemic monitoring and prevention is the job of governments rather than charities, but there are nonetheless some valuable groups working to prevent a repeat of the Covid experience. One is the Nucleic Acid Observatory, a project developing ways to surveil wastewater and other sources and notice when novel pathogens start showing up. The technologies they’re helping to build could help us catch things like Covid weeks or months earlier, and give us time to squash them before they become full-fledged pandemics.

Lead poisoning has, historically, been a major blind spot in the global health world. The extent of the problem is enormous: A landmark study found that about half of children in poor countries are exposed to very high levels of lead. At least 1.5 million people die annually from cardiovascular diseases (like heart disease) caused by lead poisoning, imposing a global economic cost of about $6 trillion a year.

But the resources devoted to preventing lead poisoning were minimal. One estimate in 2021 found that charities and nongovernmental organizations were spending between $6 and 10 million a year on the problem. That’s less than two cents per child poisoned by lead.

While there are several worthwhile charities working on this issue, I (Dylan) recommend in particular Pure Earth, which has been a leader on lead and metal contamination for decades; the Lead Exposure Elimination Project, which has been influential in fighting lead paint specifically in developing countries; and the Center for Global Development, which has become the center of lead policy in the global health world and helped mae the issue a bigger priority in recent years.

Researchers estimated that more than 1 million people died globally from antibiotic-resistant infections in 2019. Despite the emerging crisis, antibiotic research and development has long stalled. No large US or European pharmaceutical company is working to develop new antibiotics.

Fortunately, a small but growing group of researchers and clinicians has been working to revive a decades-old treatment for drug-resistant infections: bacteriophages, viruses that target and kill bacteria. Phage therapy is starting to make inroads in the US and Europe, though clinicians still have to request emergency use authorization from the Food and Drug Administration, or equivalent agencies, before the treatment can be used. Today, there are some 80 clinical trials for phage therapy in the US alone.

But while phage therapy is gaining ground in developed countries, many developing countries in Africa and Asia are falling behind, even though the burden of drug-resistant infections is highest in these countries. A lack of regulatory agencies to review and approve the treatment is one major barrier. Another is an absence of local manufacturing infrastructure, which has hindered local drug development in developing countries for years.

Researchers consistently demonstrate that phage therapy is safe and effective for treating drug-resistant infections, even those caused by bacteria that no known antibiotics can treat. What is needed now is for the phage therapy technology and expertise to be transferred to developing countries.

That is the mission of Phages for Global Health, an NGO run by Tobi Nagel and an international team of physician researchers. The organization trains laboratory technologists in Africa and Asia to study phages in their labs and partners with institutes to conduct research and develop new phage products that can be used, for instance, to prevent and quell cholera outbreaks and decontaminate poultry products to prevent foodborne illness.