Elie Hassenfeld: ​[00:00:00] Hey everyone. I'm Elie Hassenfeld, GiveWell's co-founder and CEO, and I'm joined today by our Director of Research at GiveWell, Teryn Mattox, who oversees our entire research team. Hey, Teryn.

Teryn Mattox: Hi.

Elie Hassenfeld: So the question we're gonna focus on today is, as of April 15th, 2025, which is when we're recording this, the question is: why aren't we spending more to address needs that are emerging right now? Also, how might our pace of spending and the need for funding change after September 2025 and beyond. That's a milestone because that's when the fiscal year for the federal government ends. And it's at that point that the federal government will be less constrained, have more flexibility in what it does with future spending.

We are really focused on and concerned about that long term, that post September 2025 outcome, which at this point is only several months away. [00:01:00] And so we're really thinking both about where are there needs that need to be filled right now, but also, what happens after, and how can we and the global health community respond at a time when it's fairly likely there are gonna be very significant cuts.

So Teryn, I'm just hoping you can talk through what you're seeing now and what you might think will happen to global health spending after that September milestone happens.

Teryn Mattox: Yeah, so fundamentally, I think it's really uncertain. Things are changing week to week and day to day really in terms of what our expectations are, but I can give you our best guess for right now.

So, we partnered with Open Philanthropy to commission a study with The Good Judgment Project where super forecasters, who are these experts who kind of outperform experts in the field in predicting the future. They did a forecasting project to forecast cuts to US foreign aid in 2026. And their average forecast was something like 50% overall cuts to US aid and 50% cuts to [00:02:00] US global health aid.

That forecast is consistent with forecasts we've been getting from experts and internal staff forecasts. Today's April 15th, a couple of days ago, a memo was leaked from the State Department that kind of is a point of triangulation for those forecasts. That memo indicates that they were planning to propose 50% cuts to aid for fiscal year 2026, and that includes cuts to humanitarian health and health programming, greater than 50% cuts to malaria, to US Global Fund contributions. So those are pretty significant cuts. That's a pretty dire scenario, so yeah the forecast isn't looking that great.

Elie Hassenfeld: And so some of what happened was the administration came in, they put spending on pause. Then there were waivers that allowed some spending to come through, then contracts were terminated. But by and large, the administration was limited by spending that had already been committed. Not fully limited and, a lot is gone, but [00:03:00] somewhat limited in flexibility based on what was already happening.

And then looking forward, starting in September and on, the administration has much greater flexibility to make decisions about what spending to undertake in the future, and that's where we see really massive cuts relative to last year in terms of how much global health funding will come through.

Teryn Mattox: That's right, the money for aid this year has already been appropriated. So that does limit their flexibility to some extent. However, it was back in February when the State Department came out and said, this year we're going to cut aid spending by $60 billion, 90% cuts across the board to aid. So there was a moment this year, and I think that moment is what gave rise to certainly a lot of panic within GiveWell, a lot of panic within our donor base, and just the broader community about things stopping even just this year. But the good news is it hasn't quite turned out that way.

Elie Hassenfeld: Over the next few years, the situation may be as bad and the needs may be as great as we have feared, you know, [00:04:00] something like this memo that was leaked recently presents, or the forecaster said about 50% cuts in global health aid, which would really have massive effects on the delivery of programs for people in need.

And then at times this year, in 2025, it seemed like those cuts could be even larger or come even sooner. And that, at least in the very short term, like these next several months, has not fully come to fruition. And that is one of the reasons that we haven't spent as much so far. Like looking forward, the forecast is quite problematic. And then in the present, you know, we do see gaps, we're filling gaps, but because of what was already in motion, it hasn't been quite as bad as we feared it could be.

Teryn Mattox: That's exactly right. So contracts have been being reinstated. So right after that initial announcement we were hearing from a lot of partners that were getting termination notices and, there was actually one point in the days following that initial announcement that we thought all malaria funding would be cut for this year. And what we found instead is that many contracts are getting reinstated. They're getting reinstated [00:05:00] disproportionately in areas that we think are higher impact. So that's really good news again for this year, but future years it's a lot less clear.

Elie Hassenfeld: Yeah, so I guess that's one of the main things that we've seen is that there are cases where we initially feared and the organizations we were speaking to initially feared that funding just would not come through, even for some of the programs that we see as most cost effective, including in malaria. And then, since some of those early days, when we weren't sure what would happen, we saw the legal process play out and payments start to flow to organizations so they can deliver the program that they intended to.

Teryn Mattox: That's right. So I should say there's still a lot of confusion. Just last weekend there were a bunch of contracts turned off that we thought would be on, and then it seems like some of them might have gotten turned back on again. So there remains a lot of confusion, but I think that's broadly right, and the way we know that is there are a bunch of just Excel spreadsheets floating around summarizing contract cancellations and reinstatements.

So that's what we're [00:06:00] using to make that claim, and the Center for Global Development did an analysis of all of those spreadsheets and found something like a third of the overall dollar value of USAID was terminated, and that most of that, again, was concentrated in areas like good governance and civil society, and areas like food and health and humanitarian aid were largely preserved or at least treated more favorably.

We also have done an analysis like that ourselves in the malaria space and have found that something like 85% of malaria programming, as far as we know, has been reinstated, and that includes what we think are the highest impact malaria interventions, which is a huge relief. We are actually starting to see shipments moving, payments starting, with a lot of, again chaos and confusion, but things do seem like they're moving along.

Elie Hassenfeld: And so when you say our best estimate is 85% is turned back on, I think you mean 85% is turned back on for some period of time and then it's uncertain after. Can you just break down the difference between what is happening today and then what could happen at some point in the future?

Teryn Mattox: I don't really know [00:07:00] the answer to that, it's a really good question. So some of these are very large multi-year contracts to buy malaria treatments, for example, and ship them throughout Africa. It's possible that those contracts which end in 2027, 2028, are now fully reinstated for the duration of their contract life, but I think that there's no guarantee of that.

Also in September, September is the end of the US government fiscal year, and that is when congress is going to have to allocate more money to global aid. And that is what this memo that was leaked was about, the Trump administration saying, look, come September, we're gonna put forward a proposal that total aid is cut by 50%. We're also going to try to claw back unspent funds from 2025 contracts. I don't know what that means in practice, I haven't seen the memo. So we know that these contracts have been turned back on, but there's a lot of uncertainty about what will happen in out years in malaria, and then more broadly across global [00:08:00] health.

Elie Hassenfeld: And this has come up for us right, because we've looked at some potential funding opportunities where at one point, it seemed fairly likely to us and the organizations coming to us that say there wouldn't be funding for malaria treatment in some location. And then as we look at it, what we see after is that in fact, at least in that time period, those funds are available. So then obviously, we aren't gonna come through and fund that.

Here, we're looking at those opportunities in the span of weeks or months, and that's where, at least so far, in the areas that we know best and where we focus on the most, we have not found the opportunity to give to things that we're confident really need the funding. But as we look out, like you said in September of this year and beyond that's where the cuts start adding up to potentially 50% or so, and the needs will likely be very large in the long run.

Teryn Mattox: Yeah, I would say that there's even like shorter term uncertainty than that, just in terms of what happens, even over the summer. I could imagine, for example, there are essentially [00:09:00] no staff in Washington DC administering these contracts, and that has led to a lot of confusion. On the ground, countries aren't hearing that shipments are coming, for example, so they can't plan. So I think even though things are moving, there's probably going to be a lot of chaos and a lot of, opportunities to smooth gaps in the short term, we just haven't found them yet.

Recently, we were looking into a double digit millions gap for malaria treatment commodities and trying to fast track that because if those commodities are stocked out on shelves, that's a major disaster. And then from one day to the next, we heard that these shipments were moving. So, in some of these places the very urgent needs aren't there, but I do expect that there will be one-off opportunities for us to step in, in some cases.

Elie Hassenfeld: So I guess like one of the reasons that we haven't pushed more money out the door more quickly is, when we zoom out, the timeframe in which some of the biggest needs may emerge is let's say September and on, and then a second reason might be that in this [00:10:00] short term period, as we've talked to many other organizations and looked at opportunities, we see evidence of funding being turned back on. And so, we've given some funds that intend to be recoverable if they're able to get the money. And also like as we're looking at things like it gets funded and we don't have to come through.

Another thing that you and I have talked a little bit about is that at least some organizations seem to have the cash in hand to weather short-term disruption. And so they're not just looking for what you might think of as short-term bridge funding to bridge them during this period. Could you talk a little bit about that? Like how common is it, have we seen that? Do all organizations have that kind of funding? Like how does that work?

Teryn Mattox: So not all organizations have that type of bridge funding. Organizations that were primarily funded, or exclusively funded by USAID tend to not have that kind of flexible funding to move around internally just because of the nature of USAID contracts.

But we have found that some of the bigger organizations or the organizations with more flexible funding are putting certain programs on [00:11:00] hibernation, or reallocating internal reserves to cover the very, very short term gaps. So when we're coming to gaps, our initial question is like: what is the timeline? How soon do you need funds? We haven't been hearing the story of, I need them tomorrow, it's much more, we're on a runway where we'll need them in the next couple of months. Again, there are some exceptions, I think some of the grant making that we have done has been to those more urgent needs where the organizations haven't been able to move things around.

Elie Hassenfeld: And so what explain: these organizations have some degree of unrestricted cash reserves or cash reserves that are restricted to the programs that were formally funded by the US government. And that enables them to weather a short term disruption?

Teryn Mattox: Yeah, or a flexible donor base that is giving them the option to reallocate funds.

Elie Hassenfeld: Got it. And so then what does that imply for how you think our grant making will look over the next few months? Like it seems like there's the unknown very long term where US global health spending could be much, much lower. It is, I guess very hard to know what to make of that future, except that the needs are very likely to be far [00:12:00] greater than funding will be there to provide. And we hope with more funding, we're able to do more. But when you think about, say, today in April through September 1st, how do you think we're going to approach grant making in this present moment?

Teryn Mattox: Right. So I mean, there are programs that we know have been cut definitively that we are looking into. Some of these are more urgent than others, but I expect we'll make some grants to programs of that nature. And then I also do expect that we'll be making grants to programs where that runway just runs out and organizations need more flexible funding to cover their operational costs while they're waiting for reinstatements or while they're waiting for money to come through. So I think we'll probably end up doing both.

Elie Hassenfeld: Yeah. So could we maybe start with the first, like what's an area that's been cut completely and we expect to be cut completely, such that the gap is huge.

Teryn Mattox: Yeah, and I should say that these tend to be areas that are relatively new to GiveWell. So, we are taking time to understand them before we rush in with grant making. But a couple of categories, family planning programs have been more [00:13:00] or less just summarily canceled and, that's pretty consistent with what we expected even before 2025 started, we had a sense this was coming.

Family planning is a relatively new area for GiveWell. Our new area's team had been thinking about it, and I think we're likely to make some grants there this year. But we're trying to kind of feel our way around the space, understand the composition of the donor base there, and understand the needs. So still working on kind of getting a sense of what the need is right now and what it will be in the future.

Elie Hassenfeld: And so that area is you know, an area where there was a decent amount of funding. It all stopped, we expect it to stop. Here, we're likely to do some grant making in that area. But it's new to us and we just don't know enough today to like dive in quickly and fill the most cost effective gaps. But it sounds like over the course of this calendar year, we expect to do a decent amount of work in that area and are likely to do some grant making. How will the cuts affect the kind of grant making that we do in family planning versus what we might have done otherwise?

Teryn Mattox: I think the scale of need for straightforward [00:14:00] commodity procurement is going to be significantly higher, in the past that isn't something that we've really looked at in family planning. We've mostly looked at informational style interventions to correct misperceptions about family planning so that parents can make the best decisions for themselves.

But yeah, it is looking increasingly like the funding for your basic family planning medications is going to have fallen through. So that's just a brand new area to us. And in fact, we are looking at some relatively urgent gaps, and if we think on average that procuring those commodities is likely to be highly cost effective, we'll go ahead and fill those gaps. It's just that for the longer term, for the bigger investments that we might make in the future we wanna do a little bit more work.

Elie Hassenfeld: And just to be concrete, like what were the kinds of commodities that the government was procuring and distributing before, and what are the things that, again, it's like early for us, but you could imagine us providing in the future?

Teryn Mattox: Various contraceptives.

Elie Hassenfeld: Got it. Yeah. Okay, so this was a new area that was totally cut that you could imagine us going into. And then I'm curious the other example you said was [00:15:00] organizations where they don't have this dire immediate need for funds at the like few weeks level, but might at the few months level. And we're in a stage now where we're talking to them, and potentially would make grants to support organizations, like if the funding doesn't come through over that longer timescale?

Teryn Mattox: That's right. One example of this is HIV/AIDS. This is an area that we haven't invested much in historically because it has been relatively well covered by the broader global donor base. And a lot of HIV/AIDS programming has come back online. But one area that we have a lot of concerns about are the delivery of pre-exposure prophylaxis drugs, which are given to populations that are at a high risk of contracting HIV and AIDS to prevent them contracting that condition.

It seems like, in general, that category of prevention has been cut across the board. That sounds like an incredibly urgent gap. However, country governments and implementers have been trying to integrate this [00:16:00] programming into their health systems, different funders and implementers are trying to move cash around so that they can be procuring these drugs. But I think in the medium to long term, we'll be taking a hard look at the funding of prep.

Elie Hassenfeld: So, the story that you're seeing and what I'm hearing is, the short term effects, at the level of like several months, are not quite as dire as we initially thought they might be. Even though the long-term effects very well might be as dire, and actually at this point seem to be as dire as we thought they'd be.

Let's say we're missing something, thinking about this question and how we can meet the moment well and ensure that we direct money, where it can do the most good? If we're missing something, what are we missing? What are we not getting right about this whole picture?

Teryn Mattox: Yeah, so something I've been thinking a lot about is that GiveWell has historically kind of been in this comfortable position of being a funder more at the margin. So assuming that a lot of these, like [00:17:00] basic healthcare services are being provided, how can we support at the margin to enhance those programs to save more lives. That has meant that we have not looked as systematically at more integrated health programming that now is very much at risk.

Elie Hassenfeld: When you say integrated health programming, like what does that mean?

Teryn Mattox: These are contracts to organizations that support countries or communities within countries in delivering, important life-saving interventions as a package. So you'll see a grant that covers malaria prevention and treatment, malnutrition treatment, mental healthcare, maternal and neonatal healthcare, kind of the full suite of services. And in those places, my understanding is that those contracts are the only way that, for example, malaria prevention and treatment is coming through, there's not separate vertical programming. Those programs have been summarily canceled as far as I understand.

The thing that I have been worried that we're getting wrong is not having a position on how [00:18:00] cost effective those are. And we are sprinting to try and rectify that. But in some cases, I think those programs are starting to shut down and that feels like a potential miss.

Elie Hassenfeld: It sounds like that category of program, the combined program that serves a lot of needs for a given location is one of the examples of the programs that does have short term dire needs and is at risk of just fully getting cut or has been fully cut?

Teryn Mattox: That's right, I mean, in some cases. So there are some cases where organizations, again, are using their reserves to try and maintain what programming they can, but it sounds like medical staff are getting let go as we speak. And so we've recently formed our rapid response team on the research team with the aim of trying to really quickly assess these gaps to the extent that we know about them.

Elie Hassenfeld: So one way to describe GiveWell's's response to the cuts thus far. There's a big crisis that's happening in the funding of global health. And [00:19:00] so, the first thing we did was really focus in on the areas that we knew best to be able to provide resources, because we would be able to make good decisions. In those areas, either with the organizations or the programs we knew best, we've directed about, $18 million worth of funding thus far.

And then, there's two things that have happened. In the areas that we know best, in the very short term, through say September 2025 funding has been turned back on. And it's really for these vertical, meaning single disease, often like direct delivery of health program. That's been a lot of what GiveWell has provided in the past, whether it's malaria nets or preventative malaria treatment, those get turned back on in the short term. And so, those areas that we know best don't need as much funding.

And then there's all these other areas that we just frankly, like don't know that much about yet, whether it's an area like family planning or like fully integrated care where like some of the benefit is this broad health system level support. [00:20:00] And in those cases I guess the bottom line is we just don't know how cost effective those are and where we should deploy funds to do the most good. We expect to and intend to make a lot of progress on that in the coming months, but it's just not responsible to start, pushing money out the door at all the different places that have gaps in areas that we don't know well because we just don't have any mechanism for getting those funds to the place where they'll do a lot of good.

Teryn Mattox: That's right. Yeah.

Elie Hassenfeld: I mean, how have you thought about like giving money you know, in almost like an experimental way to one of the integrated programs and just being like, what can we learn from this? We'll learn by giving and one of the best ways to learn is to give and has the added benefit of the, potential upside of maintaining some service in a particular location.

Teryn Mattox: Yeah, that's a great call out, and we were literally just talking about that in a meeting this morning. So I think a lot of these newer areas are gonna be places where we're not aiming to have a perfect answer before we deploy funds, but aiming to deploy funds with a good enough answer, even if it's a heuristics based answer, and then build in a ton of learning so [00:21:00] that not only we can learn more for that area for the future, but just so that GiveWell can like continue to mature in terms of the areas that we know about.

Elie Hassenfeld: And just like, how do you think about the tension between moving quickly, in so far as there are real needs that need money soon, versus getting it right?

Teryn Mattox: That's the whole problem. I think right now I have a slight bias towards moving quickly in areas where we have medium to strong priors that they will be high impact, like maybe this is providing healthcare in an area that has incredibly high under five mortality and no other services.

More than is typical for a year of grant making, this year, I feel more inclined to err on the side of moving quickly in areas where we think there will be a lot of impact and learning I think that on average, that will be higher impact than holding our funds until we have a significantly more certain answer.

Elie Hassenfeld: That makes sense. Thanks Teryn.

Elie Hassenfeld: Hey everyone, it's Elie again. Our [00:22:00] main focus today has been trying to address what I think in the scheme of things is a pretty narrow question. It's just, in the last two months as we've been responding to these aid cuts, we've spent about $18 million. And the question is, why haven't we spent more?

You know, as we look forward, I'd say that we as a team remain very worried about where the global health funding will be in the future. Like we said at the beginning, the memo that was leaked from the federal government and forecasts imply that cuts could come in the range of 50% across the board to global health programs. You know, if those cuts come through, and we continue to expand the scope of our research into other areas like family planning, data systems, HIV/AIDS, and broad integrated management of care, like Teryn mentioned, you know, we envision a future where our ability to help is seriously constrained by the amount of funding that we bring in.

And if you want to help us in our expanded work and our continued work, you can do [00:23:00] so via giving through our Top Charities Fund, and that will go to one of the four organizations that are on that Top Charities list, working in areas that are critical to global health, delivering cost-effective programs.
If you wanna support the full scope of our work, that could include some of the new areas we discussed today, including HIV/AIDS, family planning, and more, please support our All Grants Fund. In that fund we're making some grants that are riskier, that we're less certain about, but those kinds of grants are going to be necessary as we navigate this new world and try to learn more about the areas that need help.

Just wanna thank everyone for joining us in this conversation, for following along, and for supporting us. That support, both via engagement, but also via funding, is incredibly helpful and will be incredibly helpful into the future as we try to navigate this new world in global health with far more limited resources. And If you have any questions about anything that we spoke about or any feedback about this conversation, please [00:24:00] send it into info@givewell.org. Thank you so much.