Since our inception, New Incentives has been focused on using evidence to save lives. In this post, we share some reliable estimates of how our Cash Incentives for Childhood Vaccinations program is doing since it launched. Based on our estimates, our program has saved more than 2,645 lives since 2017.
You may be wondering, is that a lot or a little? How were these numbers calculated? Why is it so expensive – at least, some may think – to save a life? What’s included in the calculation? And what do our scale-up plans mean for our cost-effectiveness estimates? In this post, we address these questions to provide some context on how to interpret these numbers, particularly in relation to other programs.
How does New Incentives calculate lives saved?
New Incentives uses GiveWell’s independent cost-effectiveness analysis of New Incentives’ program, which estimates how much it costs to save a life with our program. Based on the latest analysis, published in March 2022, GiveWell estimates it costs about $4,600 to save a life through New Incentives’ program. The chart below provides a simplified explanation of how this is calculated.
We then look at ALL of our expenses (2017-2020 publicly available here) for each year from 2017, when the current version of the program began, through 2021, the year for which we have the latest financial data, and we divide that number ($12,167,179) by $4,601. That’s how we arrive at 2,645 lives.
Why is it so expensive to save a life?
GiveWell has a helpful post on this topic. In the case of our program in particular, one must consider the cost of the program, which is $30 per enrolled infant, the likelihood that infant will be fully immunized as a result of the program (some infants who participate in our program would have been immunized without our program), the probability of a child dying from vaccine-preventable diseases, the expected vaccine efficacy in the geographies where the program operates, and the costs borne by other actors who supply vaccines.
Concretely, it looks like this:
What $4,600 accomplishes with New Incentives in Nigeria
We’ve simplified GiveWells’ cost-effectiveness model of our program and added more context in the table below. Note that these estimates rely on a number of uncertain assumptions.
What’s included in the calculation?
A few factors add to the cost of this estimate. One is that the costs include children who were enrolled in the program but would have been vaccinated anyway. Further, it includes substantial costs incurred by the Nigerian government, Gavi, and other donors who fund vaccinations in Nigeria.
In addition, this is a careful estimate that factors in several adjustments – for example, it doesn’t assume full efficacy of vaccines and adjusts (“discounts”) for lower expected rates of vaccine efficacy in the specific region where the program operates. It also includes a downward adjustment to account for children who may be enrolled in the program multiple times despite strict measures to prevent duplicate enrollments.
New Incentives is rapidly scaling up. What does that mean for its cost-effectiveness estimates?
In principle, scaling creates economies of scale that increase efficiency and reduce costs. However, In some cases when programs scale, their impact is diluted. This can happen for various reasons, usually related to a change in the quality of the program as it expands and reaches new locations, sometimes due to different implementers or implementations within different populations or contexts. At New Incentives, we are aware of potential pitfalls of scaling with fidelity, and we are taking many careful measures to ensure we scale with impact and create those economies of scale where possible. We are constantly improving our implementation and only expanding into areas that meet a careful set of criteria. We then have robust systems in place to ensure all critical program activities are carefully tracked and accounted for.
These efforts have enabled us to increase our cost-effectiveness over time.
How do these numbers compare to other programs?
In some cases, programs have been known to exaggerate their impact to attract donations, creating a false impression that saving lives is easier and less expensive than it actually is. New Incentives uses data from respected independent evaluators to understand our impact and cost-effectiveness. Based on this analysis, our Cash Incentives for Childhood Vaccination program is estimated to be 14 times more cost-effective than cash transfers alone, and it’s one of the most cost-effective ways (known of) to save a life.