The malaria story has fair face validity if one observes the wider time series (e.g.). Further, the typical EA ‘picks’ for net distribution are generally seen as filling around the edges of the mega-distributors.
FWIW: I think this discussion would be clearer if framed in last-dollar terms.
If Gates et al. are doing something like last dollar optimisation, trying to save as many lives as they can allocating across opportunities both now and in the future, leaving the right now best marginal interventions on the table would imply they expect to exhaust their last dollar on more cost-effective interventions in the future.
This implies the right now marginal price should be higher than the (expected) last dollar cost effectiveness (if not, it should be reallocating some of the ‘last dollars’ to interventions right now). Yet this in turn does not imply we should see 50Bn of marginal price lifesaving lying around right now. So it seems we can explain Gates et al. not availing themselves of the (non-existent) opportunity to (say) halve communicable diseases for 2Bn a year worldwide (extrapolating from the right now marginal prices) without the right now marginal price being lied about or manipulated. (Obviously, even if we forecast the Gates et al. last dollar EV to be higher than the current marginal price, we might venture alternative explanations of this discrepancy besides them screwing us.)
The malaria story has fair face validity if one observes the wider time series (e.g.). Further, the typical EA ‘picks’ for net distribution are generally seen as filling around the edges of the mega-distributors.
FWIW: I think this discussion would be clearer if framed in last-dollar terms.
If Gates et al. are doing something like last dollar optimisation, trying to save as many lives as they can allocating across opportunities both now and in the future, leaving the right now best marginal interventions on the table would imply they expect to exhaust their last dollar on more cost-effective interventions in the future.
This implies the right now marginal price should be higher than the (expected) last dollar cost effectiveness (if not, it should be reallocating some of the ‘last dollars’ to interventions right now). Yet this in turn does not imply we should see 50Bn of marginal price lifesaving lying around right now. So it seems we can explain Gates et al. not availing themselves of the (non-existent) opportunity to (say) halve communicable diseases for 2Bn a year worldwide (extrapolating from the right now marginal prices) without the right now marginal price being lied about or manipulated. (Obviously, even if we forecast the Gates et al. last dollar EV to be higher than the current marginal price, we might venture alternative explanations of this discrepancy besides them screwing us.)