Will GiveWell fund Mass distribution of azithromycin to reduce child mortality by 1st January 2027?

This question resolves positively if GiveWell gives a grant or publishes a recommendation that grants be given to fund mass distribution of azithromycin on or before December 31, 2026. Or if an azithromycin distribution charity is designated a "Top Charity" or a recipient of "All Funds" before the deadline. This resolves according to a statement from GiveWell or a credible news organisation.

It resolves "No" otherwise.

The most likely resolution mechanism is that GiveWell writes "yes" in the column "Have we recommended one or more grants to support this program?" in the "mass distribution of azithromycin" row of the GiveWell program reviews spreadsheet (https://docs.google.com/spreadsheets/d/1TG7WRU85p1SEjir-5qvIEg4kVG9a4Lnzdgwcub8aKSs/edit#gid=0) or a spreadsheet that supersedes it.

Azithromycin can be distributed for the purpose of child mortality reduction or other purposes. The funds must go towards mass distribution of azithromycin, not a charity that largely does other work.

-- Note --

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-- Background --

GiveWell has recommended grants to over 10 charities over the years. They are currently investigating ~12 charity areas with other areas of research in the pipeline including Mass distribution of azithromycin to reduce child mortality.

The following sections are quoted from GiveWell’s explanation of the topic .

“In 2018, 5.3 million children died before the age of five. The highest rates of under-five mortality are found in sub-Saharan Africa, which account for roughly half of all under-five mortality.1 Respiratory infection, diarrheal diseases and malaria are among the primary causes of deaths for children under five in sub-Saharan Africa…

Azithromycin is an antibiotic that is used to treat a variety of infections.3 It is recommended by the World Health Organization (WHO) for the treatment of trachoma, a disease of the eye caused by bacterial infection.

Azithromycin may also have an impact on child mortality through its effect on respiratory infections, diarrhea and malaria.5 This effect is hypothesized to occur via azithromycin's ability to stop the growth of bacteria, such as those that cause infections leading to diarrhea and respiratory infections, and its activity against the parasites that cause malaria. However, the WHO has not approved mass use of azithromycin for this purpose…

The most credible evidence for the impact of azithromycin comes from a large-scale RCT (the MORDOR Trial). This trial finds azithromycin leads to substantial decreases in all-cause child mortality. Smaller-scale trials also find evidence for azithromycin's impact on mortality. Heavy reliance on a single large-scale trial and lack of clarity on the exact mechanisms for impact give us some uncertainty about the extent to which these results will generalize to new settings. We are also highly uncertain about the potential unintended negative consequences of antibiotic resistance caused by mass distribution of azithromycin…

We have moderate uncertainty about the extent to which the findings of the MORDOR trial will generalize to new settings…

Broad use of azithromycin may lead to macrolide-resistant bacteria, which could offset azithromycin's impact on mortality. We have only done a superficial review of antibiotic resistance from mass azithromycin distribution…

Based on a cost-effectiveness model we put together in November 2019 and updated with our most recent moral weights as of January 2021, we estimate that mass distribution of azithromycin to children is in the range of cost-effectiveness of the opportunities that we expect to direct marginal donations to (about 10x cash or higher, as of 2021). However, our estimate relies on several assumptions about which we have a high degree of uncertainty…”

Close date updated to 2026-12-31 11:59 pm

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KatjaGrace avatar
Katja Grace
bought Ṁ600 of NO

I'm betting down based on @DismalScientist's base rate, sense that results from single trials are not super likely to hold up, and the antibiotic resistance thing sounding like a mess.

DismalScientist avatar
bought Ṁ1,500 of NO

Estimated a 24% base rate among programs GiveWell listed in 2017 but had not given a grant too yet (https://www.givewell.org/research/intervention-reports/august-2017-version)

DismalScientist avatar
is predicting NO at 29%

@DismalScientist The possibility of bacterial resistance in the long-run seems like it will be hard to rule out in the next five years.