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Welcome to GiveWell’s podcast sharing the latest updates on our work. Tune in for conversations with GiveWell staff members discussing current priorities of our Research team and recent developments in the global health landscape.
Elie Hassenfeld: [00:00:00] Hey everyone, this is Elie Hassenfeld. I'm GiveWell's co-founder and CEO. Today we're gonna have a conversation about aid cuts, looking back on what has happened this year.
By far, the biggest event in our work this year was the massive cuts to US government funding that affected global health and development programs that were announced earlier this year and rolled out over the course of this year. We also expect these cuts and their consequences to persist in the future years.
These cuts caused us to step back and rethink how we could best respond to this massive shift in funding for the sector. It ended up causing us to look at some different programs and fund some grants that we otherwise might not have. But generally speaking, we stayed the course in our general approach to work, which is focusing on maximizing impact via rigorous research that focuses on truth-seeking and then publishing our results [00:01:00] and being transparent about what we found.
And so in many ways, while we focused on some new areas and programs, very much the challenges we faced this year fit into GiveWell's longstanding approach to research and to giving.
Over the course of the year so far, we've directed about $40 million to programs as a direct response to the cuts, and that's in addition to more than $220 million that we've directed to other programs.
So today, I am speaking with Teryn Maddox, our Director of Research. Teryn oversees our entire research team, she's in charge of all the research and also sets our agenda and strategy.
And I'm gonna ask Teryn to reflect on the year and think about questions like, how did our response to the cuts evolve? Looking back, where did we most clearly succeed? What did we get wrong? What could we have done better? And then on the cuts themselves, where do things stand today, and what does it mean for next year? What does she think people might get wrong about what has happened so far, and what might happen in the future?
And so we're gonna talk about all that and, hopefully, [00:02:00] provide some context on, you know, how this year has gone for us and what we've seen. So, Teryn, thanks for having this conversation with me.
Teryn Maddox: Thank you for having me.
Elie Hassenfeld: So why don't, we just like start back at the beginning and, curious how our response to the cuts evolved.
Teryn Maddox: Right, so kind of transporting back to late winter, early spring of this year, I think, the hardest part at the beginning of the year was just figuring out how to respond—both be responsive and respond well and quickly where it made sense, without making decisions we'd later regret, while kind of holding true to our rigor and truth-seeking and making sure we were, you know, continuing to maximize the impact of our donor dollars.
So, what that looked like was kind of a two-pronged initial strategy where, on the one hand in terms of grantmaking and actual monetary response, we were focusing on the areas where we had the context to move forward with [00:03:00] confidence. While at the same time, the second prong was starting to build that context in areas that we thought we might need to move into in the future.
So, on that latter part, this kind of like context building, in the spring, we formed these two “tiger teams,” and their goals were simply just to understand the full potential scope of cuts. Like what if all aid goes away? What should we prioritize in terms of disease areas, countries, programming?
And so, that work that kicked off in the spring, you can almost imagine the output of that being a heat map that included lots of different programs, lots of different disease areas, countries. And that was a guide for us to understand, you know, if these cuts come, depending on where they come, here are the places that we'll want to focus. That ended up being really helpful as where the cuts materialized became more clear.
Then on the other hand, in terms [00:04:00] of focusing our actual grantmaking in the area that we had the context to move with a lot of confidence, malaria in general stood out as an area that we did have already that context. We had the knowledge, we kind of had the stakeholder relationships, cost effectiveness modeling, et cetera in place to be able to both hear about real gaps as they emerged and to respond quickly. And, again, with that confidence that we weren't making some horrible mistake with our donor dollars.
Elie Hassenfeld: Right, when the cuts first happened, you know, I think there was this like initial instinct that at least I know I felt, which was, all this money's gone away. There must be these huge needs. We just gotta like do something.
And what became clear is in some cases—many cases, many areas—we hadn't done any work in the past, and we just weren't going to be able to make good decisions. There was a lot we didn't know about what was happening on the ground in terms of where money was flowing. But in an area like HIV, which has been [00:05:00] so heavily funded by the US government historically, we just didn't know enough about the programs and the players to be in a position to make good decisions.
And so we took this approach, which was on one hand, looking at areas where we already knew a lot and we could make grants quickly because of that historical context and then, you know, in other areas building up context that could just help us get set to be able to do more later on.
Teryn Maddox: That's right. And I would say it definitely was a lot about the research that we hadn't done, but it was also the case that just staying on top of literally what was happening day-to-day and getting good information was based in like really strong partnerships that we had established prior to the cuts.
So just not having those partnerships in some of these areas that were impacted or were likely to get impacted meant that we had very low information in terms of what was going on. So even just knowing what was happening and what we could respond to itself was a longer term effort in areas where we didn't have those relationships.
Elie Hassenfeld: In an area where we had a longer history in [00:06:00] deeper partnerships, say malaria, can you paint a really concrete picture of the kind of information that we were able to get, the questions we were able to answer in areas where we had these deep partnerships and long-term relationships? Versus an area where we didn't have those relationships and so the information we needed was just not available to us?
Teryn Maddox: So I think the information that we were able to get in the malaria space specifically was really timely and related to programming that needed funding like imminently in order to proceed. And the reason that we were able to get that information was because we had these preexisting relationships.
We could, as soon as cuts hit, go out to these organizations that we have built connections with over years of funding and say, what does this mean for your work? And so we were able to hear very early on, you know, from these organizations that we partnered with and their peers in the space that they connected us with. For [00:07:00] example, you know, the rainy season is coming. We need to plan for this campaign to give malaria preventative medication to under five children in this country. We don't know if the US government is going to come through or not. We don't want to expend our precious resources, our cash reserves on planning for this thing that might not come to pass. But if we don't plan, we're not gonna be able to do this program in time.
So we could have those conversations and have the confidence in the programming, you know, know what questions to ask about the programming, and ultimately have the confidence in the cost-effectiveness, the impact of that programming to say, okay, what we're gonna do is we are going to support you for planning, and in the event that the US government doesn't come through for full implementation, potentially even support that so that these organizations could move forward with confidence.
We didn't have those kinds of relationships in a space like HIV, so we didn't even have the level of relationship where we knew the players to go [00:08:00] to to say, what do you need? What's going on now? And if we had gotten that information from them, it would've been harder for us to assess where we should have invested, because we haven't done that kind of like landscaping research to the same level we have in malaria.
Elie Hassenfeld: Got it. So there's these two challenges we faced early on. Like on one hand, anytime we evaluate giving to a specific program— so that could be malaria nets, that could be giving to support viral load testing in HIV—we want to look at the underlying research that tells us how effective the program is, how cost effective it is, and we that takes some time in order to have any sense of the impact per dollar that will be achieved.
And then, in addition, this might be counterintuitive to folks, but a major source of information that goes into the research we do is just talking to people who are operating programs, asking them about how those programs work, having them share information and data with us, then asking them questions about that data so we can really understand it. And that just requires a lot of time. It requires [00:09:00] relationships, because it's always the case that when you're engaging with someone that you have a closer relationship with, it's much easier to get good information when that relationship is stronger than when it's weaker.
And so in an area like malaria, we had both of those two prongs ready. Both the relationships and the underlying research, like on day one. And then in an area like HIV, we had neither. And that just meant that the thing we had to do on day one was not figure out what grants to make, but instead just, you know, put our foot on the gas with respect to building context so we'd be in a position to do better later.
Teryn Maddox: That's right. And the reason that we had neither of those in HIV is frankly because for a very long time, US government funding, especially via PEPFAR, has covered a lot of the most cost-effective HIV programming work. It's also a big priority of country governments where HIV is a problem. So, you know, it's felt more or less covered, and the margin that GiveWell could participate in the HIV space has felt less impactful than the margins in some other cause areas.
[00:10:00] And just thinking about the size of the US government's funding for HIV and AIDS, it's something like $6 billion a year, compared to something between one or two for malaria. So it's this huge amount of funding and that's both why we weren't really as engaged in that space historically, and then it's also why now, it's a big priority for us.
Elie Hassenfeld: Yeah. And so, let's just take one example. Is there an area that we began building context back in Q1 this year, and you know, now we've built up more context and as you look forward, it seems like an area that we could potentially be focused on?
Teryn Maddox: Yeah, there are a few. I mean, I'll stick with HIV, I think it's important to underline this area, not just because the US government funded so much in HIV, but also because of the way they're approaching cuts here.
So, in other areas like, take malaria, our understanding is that the prioritization of remaining funds [00:11:00] in the malaria space has been pretty good. So the US government and related partners and country governments are prioritizing malaria treatments, malaria prevention, that we would, as GiveWell, also prioritize.
There's a little bit of a difference in the HIV space where not only is the US government such a large funder, but they have, you know, for political reasons, signaled a deprioritization of certain “key populations” is what they're called in HIV. So, men who have sex with men, and female sex workers are examples of those that might be less of a priority for future grantmaking.
So, unlike in malaria where we do feel like, at least at the very broadest level, prioritization of remaining malaria funding is going really well, there might be this like significant gap in HIV where funding for these key populations, that you can imagine are potentially the highest risk and the highest impact populations to work with, might be going away. So there's this kind of like broader context around prioritization within the HIV [00:12:00] space that makes that look more interesting for us to engage in.
And then I'll even add on top of that, at the same time, essentially like almost concurrent with these aid cuts, a brand new HIV preventive medicine came online. It's a medicine you don't have to take as often that's really effective at preventing HIV.
So these three things combined, you know, the like total dollar amount that US government was contributing, the fact that these key populations are potentially being deprioritized, and this like new, exciting medicine is coming online, make this a really exciting space.
And so, we have accelerated our context building in that space. And I do think that this is a place where we'll be making potentially grants this year, probably grants in future years. Something that we're looking into right now is around that new HIV preventive medication. Are there opportunities for GiveWell to participate in accelerating the rollout of that medication in places where it may not have been a priority or at least [00:13:00] broadening the population that it's being delivered to? So I find that really exciting.
Elie Hassenfeld: And so I think that medication is lenacapavir. Can you just say a little bit about how it compares to the existing treatment, just in terms of you know, how often to use it.
Teryn Maddox: Yeah, yeah. So when you are in a population that's at high risk of contracting HIV, you're eligible for, you know, this is available in the US, it's also available in Africa, it's pre-exposure prophylaxis, it's called PrEP. And it's a daily pill you take, and it prevents the transmission of HIV, it's pretty good at doing that.
The problem with the daily pill is not just that you have to remember to take it every day for it to work, but also you've gotta go in every month and get your prescription filled.
Elie, you and I were in Malawi, we talked to a bunch of clinicians about, you know, challenges associated with PrEP. And a lot of them were saying, you know, folks live really far away from the clinic. Just getting to the HIV clinic to get their prescription filled is hard. On top of that, there's like so much stigma associated with literally walking through those doors. So to the extent you can reduce the [00:14:00] touch points involved, and get people coverage for longer, that's just gonna be a much more effective prevention regimen.
So lenacapavir, you can just go to the clinic, get an injection once every six months, and it is extremely effective, I think it's over 90%, maybe over 95% effective at preventing HIV transmission. So it's potentially a game changer in the space.
Elie Hassenfeld: You know, I think all of this just like helps illustrate the work we were doing this year, and the kinds of questions we had to answer to be in a position to make cost-effective grants that we had confidence in. You know, first question is, well, what does the research say about how effective these programs are? What do we know about how cost effective they are in general? The second question is, what's happening on the ground right now? Like, who needs money? Where is it flowing? What are people doing? You know, there, we needed relationships. And then there's this maybe a third area that you just mentioned, which is, to what extent will the funds that remain prioritize cost-effectiveness versus other considerations?
And you know, you laid out this dichotomy where in [00:15:00] malaria it at least appears so far, that cost-effectiveness has been a more significant criterion and prioritization in HIV, perhaps not. And then for us, because we're a group that prioritizes cost-effectiveness, you know, we are then looking for the areas where there are gaps. And there are more likely to be larger gaps in areas where other major actors are not prioritizing cost effectiveness. And so if that's the case with HIV, then that becomes an area that seems more likely as one that we'll fund.
And of course, the challenge with all of this is we don't know. And so the only way that we're able to make the decisions about funds is by doing our work every day, staying in touch with these groups and seeing how this plays out. Because the only way to know where the gaps actually exist and persist is based on the information that we, you know, get every day by talking to people and seeing what's happening.
Teryn Maddox: That's right. And I should say that like again, the information environment has been maybe the biggest challenge across the board this year. And it has improved, like we understand, I think, a little bit more about the US' intentions, and what is [00:16:00] likely to be coming down the pike, but not that much more. There's still a lot of uncertainty about what's coming in future years, and so we're still navigating that general environment of chaos, and still trying to make good decisions within that kind of lower information environment.
Elie Hassenfeld: I wanna talk more about the future, but first I still wanna be looking back and really interested in your reflection on both an area where you think we as an organization and a team did really well and succeeded. And then of course, you know, really interested in areas where you think we got something wrong, or could have done better, or maybe even we've learned something and we will do better in the future. But yeah, let's start with the first half of that, what's something that, looking back, you think we did really well on?
Teryn Maddox: There was a real risk early on, I mean, I felt this pull that I wanted to pivot us really intensely towards some hypothetical worst case future and direct as much of our attention as possible to that future, even amidst the chaos. It was almost like a coping mechanism, and I know that other people on [00:17:00] the team felt that too, like, the way we can navigate this is by doing something.
But I think a thing that we did really well as a whole team is not overcorrect and not turn too much of our focus towards trying to understand the day-to-day ins-and-outs of what was happening. I actually think the team did a really excellent job of navigating all of that.
And there were some sub-teams, so we have like grantmaking sub-teams, that their work didn't really change very much at all. And their message to me was, I don't expect this to affect us very much, I'm gonna keep on towing the line, and I'll keep talking to people and make sure I understand whether it might.
But I think like broadly, I'm really proud that we didn't overreact, but that we also did, I think, make some really highly—potentially the highest impact grants we'll make this year, we did make during that time as part of a like well-reasoned response to what we were hearing.
Elie Hassenfeld: And what do you see as some of those highest impact grants?
Teryn Maddox: Yeah, I mean, I think, again, going back to the [00:18:00] malaria example, there were just a lot of cases where we provided what I'll call like a funding guarantee, or a pledge, or a backstop. Something that allowed work to continue in the context of a lot of uncertainty, where we didn't end up having to release all or any of those funds.
So the example that I mentioned where we provided planning grants for these malaria prevention programs to go forward, that was just a super highly leveraged, those were a couple hundred thousand dollars but meant that these organizations were ready to deliver malaria prevention programming ahead of the rainy season across six countries in Africa. You know, that's an example, and I think there are a bunch of examples like that where we were flexible and willing to step in, and ended up not needing to pay for the full implementation, or even getting some of our money back.
Elie Hassenfeld: Right, and if folks are interested in more on this one, Natalie Crispin and I discussed this exact grant in greater length in episode 17 of this podcast series.
So [00:19:00] Teryn, let's do the other side of this equation. What did we get wrong, or what could we have done better? And maybe even, like, what do we not do as well as we could have that we've learned from, we'll be able to do better in the future.
Teryn Maddox: Yeah, there's so, I have so many thoughts on this and it's hard to determine how much of this is just hindsight is 20/20. I think something that is hard for us at GiveWell is adapting to just like a high degree of uncertainty, even for potentially like very large grants.
So one thing that I think, just speaking for myself, that I wish I had done more was a little bit more active support and pushing of our team to be comfortable with a higher degree of uncertainty in our grantmaking where it made sense. I think we tend to want to get all the way down to the studs and like really understand a program all the way through and through. And sometimes doing that is not the highest impact activity. In fact, it's [00:20:00] higher impact to make more grants that we think on average are really cost-effective, even if one is going to end up not looking as good in retrospect, if that makes sense. And I think that there was more messaging and actual modeling that I could have done for the team on that.
Elie Hassenfeld: And so it's like a really hard balance to strike. You know, on one hand, the argument's like, well, if you can make more grants, especially at a time of high need, it's likely to have impact even if some number don't go the way we hope. And then on the other hand, the whole thing that we do, the whole thing that we built a team around is, these deep, rigorous investigations.
And so help us understand how you think about this. I mean, I don't know if there's like an example you can bring or maybe like a concrete case where you're like, wow, we really did more than we had to, we should have just gone ahead and… because it seems like on some level conceptually clear, but practically so challenging.
Teryn Maddox: At the very start of the year, I formed, directly reporting into me, what we called the skunkworks team. And it was a team that was aimed at doing rapid [00:21:00] response grantmaking, where I could credibly say, I will sign off on grants that might have like a little bit less due diligence than we've done historically. And so that grantmaking team ended up making something like $5 to $10 million in grants, before we realized that that function would be better suited sitting on specific sub teams.
But in the intervening time, you know, I have this example that I kind of lived with the team that was working on it, which was also covered in the recent Planet Money podcast, which was a grant to an organization that we knew well, named ALIMA, in a program area that we did not know as well. I call it horizontal as opposed to vertical, so it covered lots of different disease areas. ALIMA was going into hospitals and clinics and supporting the Ministry of Health across essentially almost all of their programming and health clinics, but focused primarily on pediatric care.
That's just kind of not a model that we have engaged with much in the past. And, specifically when trying to kind of value all the [00:22:00] benefits, it got a little sticky. I think that that's a case where even I had a hard time moving forward in the amount of uncertainty that we had.
So we spent a lot of time trying to understand just what mortality looks like in this place where it's fundamentally not understandable. So this is like a refugee camp where mortality estimates are very noisy and the populations themselves are always moving. So even if you get a good mortality estimate, it's not gonna be valid next year, 'cause the populations are so in flux.
And I think it's a very “GiveWell-y” thing to do to work really hard to try and get a precise estimate of mortality in a place, which is kind of what we did. And something that we ended up leaning on much more was this series of like triangulation efforts that all pointed to the general [00:23:00] fact that this is probably a very high impact program.
So I guess what I'm trying to say is that I think we spent, in that case, more time than necessary trying to come to a precise estimate, where these points of triangulations that were all pointing to the fact that this was probably at or above our bar were sufficient.
Elie Hassenfeld: Yeah. And so then, I mean, do you expect we'll be doing a lot more of that kind of reasoning in the future? And if so, how do you think that'll affect the impact that our grantmaking has?
Teryn Maddox: So by that kind of reasoning, I think you mean these like sideways sense checks? Definitely, that will be more something we're doing more of in the future.
We haven't touched today much on the fact that USAID was funding just a mind boggling amount of kind of general health systems strengthening activities. These are things like supply chain management, education, and support. You can think of these as like the ultimate horizontal program, right? Like [00:24:00] you have a strong supply chain, it just touches every aspect of your health system. And so I do expect that this sense of like building an extremely precise linear model is just not going to be appropriate for programs like that.
And so building in more of these sense checks, getting more sophisticated about how we do these kind of sideways checks is definitely going to be happening more in our future for these types of kind of more nebulous programs.
But also I think we haven't done enough historically of these sideways checks on just our bread and butter. Like, does it make sense what this linear model is spitting out? So yeah, I think it's a lesson we'll take into the future and that we'll apply kind of across our programming.
Elie Hassenfeld: Looking sort of across what we did this year, what's your sense about what people might not quite understand or might get wrong about what happened this year?
Teryn Maddox: I think there are a lot of misunderstandings just because there has been so much happening in the news, not just with respect to aid, but just [00:25:00] in general in the news. And so I think it's likely I'm getting something wrong, I think the people listening are probably getting something wrong. You know, again, the information environment is a little tough.
But one thing that I hear a lot from our donors is there are these like massive cuts happening to the US government right now. Why isn't GiveWell shifting everything to address those cuts? Why isn't our threshold for grant making going way up? Because, you know, the US government was spending $12+ billion a year on global health alone. If that's cut in half, it seems like GiveWell should be spending at a much higher cost effectiveness bar. You know, why hasn't this changed your strategy more? And so I think there's a couple of misunderstandings, kind of like tangled up in this question, but I think it's like a really important thing to suss out.
So first, I think a lot of folks don't totally realize that the cuts so far have been relatively limited. There are certainly some areas like family [00:26:00] planning where cuts have been much more complete, but in most life-saving prevention programming, cuts have been relatively limited. Of course, we don't know what will happen in the future, but most funding was reinstated for 2025 in lifesaving health programming, and Congress appropriated the same amount for next year for aid.
Elie Hassenfeld: And so does that mean in lifesaving programs, just to make sure I understand, that there was this period early in the year where some of these funds stopped flowing. There was also a period where there was huge uncertainty and that meant that some of the guarantees we could provide to the planning for malaria campaigns was very helpful. There was this bad effect early in the year, but as the year went on, mostly the funds you're describing came back and we expect them to be there next year as well.
Teryn Maddox: So most of the funds came back this year. Of course there was a lot of friction, as I described, in that intervening period that led to some bad outcomes, I think. But yeah, most, have come back online for this year.
And then in terms of what's happening for next year, the full amount has been appropriated, the same amount [00:27:00] that was appropriated for 2025 has been appropriated for 2026. And there's definitely ways that that spending could be reduced or delayed for sure, but the way that that money will be spent is totally different. And so we don't know exactly what will come of that new kind of approach that the State Department is taking to spending that money.
Elie Hassenfeld: Say more about that. What do you mean by the way in which the State Department will spend the money is different? In what ways is it different?
Teryn Maddox: So under the old system, USAID is this like big implementing agency for the US, not just for health, but for development across the board, you know, health education, economic policy, humanitarian response. And so USAID is this very large institution that takes all this money that's been appropriated by Congress and delivers aid via contracts with nonprofits, academics, some private sector partners. And this agency, this big USAID agency is directly overseeing kind of the [00:28:00] design and the execution of those contracts. So it's kind of this big behemoth organization that is the vehicle through which appropriated aid is delivered to countries.
USAID as an entity is gone now. And what is happening now is aid is centralized in the State Department. I think part of the intention there is to better align aid with the US' diplomatic strategy. So the way that they are going about that is instead of funneling funds through a middleman, there are direct, you know, bilateral—which means like government to government agreements—being authored between the US government and recipients of aid.
So those negotiations are happening right now, and what we are hearing is coming out of those is like a top line budget that is being negotiated, an extent of government co-financing being negotiated. They're negotiating what disease areas will be included. And then my understanding, at least as of [00:29:00] right now, is that the expectation is that the vast majority of those funds will be flowing through the country governments themselves. So they will be expected to stand up programs as opposed to having this USAID come in from the outside and fund programs that are kind of running in parallel.
So back to kind of the misunderstanding. I guess all of that to say, you know, it's not clear how much will be cut in the future. So all of this was appropriated, the same amount as historically. What happens through those country negotiations will determine, I think, a lot of our understanding of what's going to happen in 2026 and 2027.
But I think it's fair to say that global health aid levels would be at like 50% to 100% of what they've been historically. So the question remains, if that's the case, do we expect there to be like massive, highly cost effective gaps that GiveWell should expect to fill in the future? And counterintuitively, my answer is I'm not sure that that's true. Should I go into that? Why that is? [00:30:00]
Elie Hassenfeld: Yeah, definitely.
Teryn Maddox: Okay. So, first of all, to start with, I think something that I can't emphasize enough is that the GiveWell bar is extremely high. It is very hard for us to find giving opportunities that meet our cost effectiveness bar in terms of dollars per life saved. If we were a $12 billion a year organization, if we were as big as USAID, we would have to drop that bar, there just aren't that many opportunities in the world at our bar.
So, you know, if USAID were prioritizing, its $12 to $15 billion perfectly, I think the vast majority of that would already be below our bar. You can imagine this like iceberg, where something like 5% to 10% maybe is above whatever the GiveWell bar is, if they were prioritizing perfectly. And then you add on top of that, that USAID has not historically prioritized their grantmaking perfectly.
A really interesting example to me, you know I mentioned that the vast majority, like 95% of malaria is in [00:31:00] Africa, you know, 20 countries in Africa. Only around half of US malaria funding goes to those 20 countries. Thailand gets US government malaria funding and it receives about 20 times the funding per under five malaria death than in Nigeria. So this is just an example of how that money is not prioritized according to like necessarily the highest impact opportunities. There are other diplomatic reasons to spread money around.
So if that iceberg were perfectly prioritized, maybe 5% to 10% would be above our bar, it's not perfectly prioritized. And then on top of that, as we've kind of seen countries kind of reveal their preferences and the US government revealed their preferences for what gets saved, like I said, with the exception of some of these key populations in HIV, it seems that the programs that we as GiveWell think are the very best in terms of immediate, direct lifesaving impact have been maintained.
So, for example, countries and the US government seem to be [00:32:00] prioritizing having medications on shelves to treat folks when they come into the clinic with malaria. That's a very high impact program, making sure that those commodities are on shelves, that seems to be being maintained.
So, a small portion of USAID funding is above our bar. I think among that, a lot of it is getting prioritized by the US government. So all of that combines to mean that at the end of that, I don't know that there will actually be hundreds and hundreds of millions of opportunities that are above our bar.
We're probably gonna spend around $50 million this year, all in. We might spend $100 million plus next year, depending on where things land, but it's definitely not going to be this seismic shift that I think many people expect when they first hear about the cuts.
Elie Hassenfeld: And in those $50 and $100, you mean spend on grants that are directly responsive to the cuts?
Teryn Maddox: Yes, that's exactly right.
Elie Hassenfeld: We've been talking almost entirely about what has happened. We've touched a little bit on the future, but maybe let's just close with, you know, what’s on your mind looking ahead? What do you [00:33:00] think it means for next year, and how do you think it's changed what you expect from GiveWell in the future?
Teryn Maddox: So of course to start, I think that we will be shifting our focus into more new areas, including HIV for the reasons I mentioned. But I do think that I am hoping that our team can just generally start to cover more surface area in terms of understanding more different areas that we haven't understood before.
And what that looks like, I think, is potentially making more learning grants in new spaces like health systems strengthening or family planning, so that we can start to build context across multiple different dimensions kind of quickly. So that we're readier to respond as cuts come through or the environment changes.
And like I said, I do expect us to, because some of these areas are newer and require a different way of thinking about how we can quantify their impact, I expect there to be changes to our overall [00:34:00] approach to assessing impact so that we can include program areas that might be cut that we hadn't really looked at before, like health system strengthening.
Elie Hassenfeld: That's great. Anything else you wanna add before we wrap up?
Teryn Maddox: Just that I think I'm grateful to all of our donors. I feel like it's been really encouraging to have such an engaged and interested donor base. And, I don't know, it's felt very encouraging from the research side to know that we have donors who are staying on top of all of this and really care, and thank you for that.
Elie Hassenfeld: Yeah, I really appreciate that everyone, and thanks, Teryn, for this conversation.
Teryn Maddox: Thanks.
Elie Hassenfeld: This is Elie again. You know, a lot of what we were talking about in the time we spent together was this challenge that we really faced all year, which was on one hand, how do we balance impact, putting money out into the world where it will do good? Obviously, money can only do good if we direct it to organizations that are working to help people. Against the challenge of not knowing [00:35:00] enough. We want to understand, we want to know enough about where money is going so we can be confident that it's having the kind of effect that we expect and that I know our donors expect when they support us, when you all support us with money. And so that was really the big challenge, just the tension we were navigating all year long.
So much of what is happening today and what will happen in the future remains unclear because it's changing. This was a key issue we faced throughout 2025, and odds are we're going to continue facing this going forward. We need to answer questions like how cost-effective is this program? What impact per dollar will it have? And that requires deep research and modeling. We need to understand what's happening on the ground and, you know, that requires relationships where people are able to help us understand the data they share, but also give us the real deal about what's happening. You know, that requires a certain kind of relationship and openness that helps us feel confident in our understanding of what's going on.
And then, you know, just thinking about what the US government and others might do in the future. There are these large funding [00:36:00] pools that for a long time were fairly static in how they supported programs and now there's upheaval. And so we have much less clarity on what they will be funding in the future.
Of course, these challenges mean that there are opportunities to have more impact, and also opportunities to learn and evolve GiveWell's research process so that we can do better. And you know, the grant that Teryn described to ALIMA in Cameroon that we've talked about in the GiveWell podcast and also was covered by Planet Money is just a good illustration of one way in which the core values of GiveWell, this focus on maximizing impact and doing that via research that is truth-seeking and committed to transparency, you know, really comes through, even though the literal tool we apply is different in that case than in many others.
Thank you all for listening, for your engagement, and for your support this year. If you want to support our work, you can do that via our funds, our Top Charities Fund, All Grants Fund, or supporting us unrestricted. You can read more about all of those on our website.
And as always, if you have feedback about [00:37:00] issues you'd like to see us cover, things you think we got wrong, or questions you'd like to see us answer, please email info@givewell.org. It'd be great to hear from you, we'd love to hear what we could be doing better, both in these conversations, but also in GiveWell as a whole. Thank you so much again for your support this year, we're extremely grateful.