This is an edited transcript of an episode of “The Ezra Klein Show.” You can listen to the conversation by following or subscribing to the show on the NYTimes app, Apple, Spotify, Amazon Music, YouTube, iHeartRadio or wherever you get your podcasts.
This article is part of Times Opinion’s 2025 Giving Guide.
It is the holiday season, and many years ago, during the holiday season at New York Times Opinion, Nicholas Kristof kicked off a tradition that I love. Different columnists and parts of the organization now offer up their recommendations for giving, and it’s one of my favorite things about being here: trying to make people aware of charities they might want to support and where money that they can spare might do a tremendous amount of good.
In my personal giving, every year I donate to a local charity, but then I also contribute to GiveWell. Out of every organization I have known, I have the most trust in GiveWell to do the vetting, to run the experiments, to read the research — to really figure out where my money will go the farthest in helping other people. GiveWell has not been around that long, but in the time they have, they’ve become a pretty big channeler of givers’ funds for this exact reason: because a lot of people trust the work they do, because it is so transparent and so rigorous. Billions of dollars have been given through them.
So I am recommending that if you have money to spare, you consider giving some of it through GiveWell, which you can do at givewell.org. But I thought rather than writing a column, I would have Elie Hassenfeld, GiveWell’s chief executive officer and one of its founders, on the show to talk about how GiveWell started, how it works, how it makes difficult decisions in terms of what to recommend and what not to recommend, and how givers themselves should think about donating money — to whom, to where and under what conditions — as we all wrestle with how we can do a little bit more good in a world that needs a lot more good done.
Ezra Klein: Elie Hassenfeld, welcome to the show.
Elie Hassenfeld: Great to be here.
I want to start a little bit before your work at GiveWell. You studied religion at college, which is not what I would expect from somebody who goes on to work at a hedge fund and then becomes an apostle of cost-benefit analysis and randomized controlled trials.
Why religion?
I think in an alternative life, I’m not doing what I’m doing here at GiveWell. Instead, I’m an academic studying the Talmud. It was something that, at the time, I was incredibly interested in, and in college I spent a lot of time in Talmud courses studying other religious texts and Judaism and otherwise. I just found it incredibly fulfilling and interesting to think about how people had tried to answer questions about their lives.
What is the Talmud, for people who don’t know? And what did you learn from studying it?
It’s a huge compendium of Jewish ideas and thought from roughly the 500s of the common era.
The thing it taught me most is how challenging it is to know anything. I spent about a year just studying Talmud, and in that year after high school, it was the first time that I think I had a really challenging intellectual experience where I wasn’t able to understand the text and the content that I was trying to — but nevertheless found myself drawn to understand it and to deal with the layers of challenge that the text presented.
So I spent a year doing that. And then when I was in college, I would say that this was my main extracurricular activity outside of school — spending several hours a day studying Talmud.
But in thinking about whether that was something I would do as a career, I ultimately realized it wasn’t the right fit for me.
You moved on to Bridgewater, a very unusual hedge fund. What is that movement for you?
As I moved through college, I was thinking about what my career would be and had the opportunity to have internships in many different places. My parents are both lawyers. I got to work at a law firm. That convinced me not to go to law school because I didn’t think that would be right for me.
I was able to get a job in finance at a small company. They were essentially selling research to the big banks and just trying to figure out how to succeed as an organization. Because of that, they were willing to give me, a 21-year-old college kid, a lot of leeway to try to do things and help the company grow. That experience, of being in a place where I was needed and able to do something interesting and challenging, motivated me to look for jobs in finance coming out of school.
I was able to get a job at Bridgewater Associates, which in 2004, when I graduated college, was not well known at all. Everyone I talked to said: Don’t go work there. Go work at a well-known investment bank. That will be better for your career.
But when I interviewed there, they asked me about my senior thesis. I was a religion major, so it was about martyrdom in medieval Islam, Judaism and Christianity. We talked about that for an hour, and I got a callback. And it was one of the few places that called me back. You might not be surprised to hear that religion majors don’t often do so well interviewing for finance jobs.
And because of that, I thought that Bridgewater was just one of the more interesting places to go work, and I was grateful to be able to work there.
So Bridgewater later became fairly well known because it’s Ray Dalio’s hedge fund. Dalio, of course, is a sort of public finance intellectual now, but he had a very strange and famous management style.
What was working at Bridgewater like? What was unusual about working at Bridgewater at that time?
Bridgewater is known for its culture of radical transparency. Just saying what you think, sharing that with your colleagues. Not worrying too much about how you say it, but just saying what you believe. And then over time —
Or about how they’ll feel about it.
Or how they’ll feel about it. And over time, Ray developed these principles that were passed out inside the organization. The way I described it to my friends at the time is it felt to me like working in almost an academic environment. People didn’t wear fancy clothes; they argued a lot about ideas. Sure, there were ways in which I think the culture wasn’t ideal for many. It was a place where it was more about getting things right — and then worrying about people’s feelings later. And if that wasn’t the right fit for you, then people moved on.
But for me, it was an extremely valuable experience. The thing that I appreciated, certainly as a young person in my early 20s, is I would go to my boss sometimes, and he was one of the heads of the company, and say: Hey, I think you’re wrong about this — and he would listen to me. And sometimes I was wrong, sometimes I was right. But to be taken seriously early in your career was so valuable and something I’m really grateful to them for providing me.
I think this is relevant to what you end up doing at GiveWell. Because when hedge funds and investment banks are trying to understand a company, a sector, a quirk in the market, at a level where you can make a trade other people will not make, you’ll lose a lot of money if you’re wrong.
So what is the pathway to having something of any value to say?
I think the core idea that was true then, and I think has carried through in GiveWell and in my life today, was first, in order to make decisions about what to do in the world, we have to understand the world accurately.
For a hedge fund, understanding reality is really key. If you are right, you make money — or you can. If you’re wrong, you tend to lose money. So the stakes of getting to the “truth” are very high.
Part of that is you have to be careful not to fool yourself. So one of the things that investors do is they have an idea about what might perform well in the market. And then you can say: Well, how well did this idea perform historically? And you can backtest the idea. And when you do that, you have to be really careful not to fit your idea to the past. Instead, you have to ask this question —
Wait. Can you describe what that would mean?
So you might say a simple rule, like, let’s say — I’m going to make something up that’s entirely fictitious: If oil prices go up, then train stocks go down, because an input into railroad costs is the price of gas. So when the input cost goes up, the performance will be poor. And you could try to look at this historically, and let’s say we tested this going back: Would this have been a successful strategy in the market?
The challenge is that it’s very easy to convince yourself that you should tweak your rule in one way or another to enable the idea that you have to perform on the backtest. But you don’t want to do that, because you only want to bet money on this idea if it really will work.
So you’re working at Bridgewater, a hedge fund — I would say, one of the more acquisitive industries that exist. Where does your interest in giving as a pursuit — and giving differently — come from?
I’d been there for a couple of years. My friend had a friend there, Holden Karnofsky. And he and I just started realizing: We’re young, we don’t have high expenses, we’re saving some money. Let’s try to use some of this money to help people.
So back in the summer of 2006, he and I and a few others got together and said: Let’s just work on figuring out where we’ll give by the end of the year. You know, a few thousand dollars.
It was in that process, with that group of people, that we learned a few things. First, we learned it’s really hard to get answers about what charitable organizations do and how well they work.
Second, I just found myself somewhat obsessed by this question of where we should give. At the time, I knew very little about what the lives of people around the world were like. It’s not something I had studied, it’s not something I knew much about. But learning about the challenges of accessing water or of disease was just a very motivating topic to work on.
And I remember this night in probably December of 2006 — I was up at 2 a.m. or 3 a.m. reading academic papers about diarrhea in Africa. If you find yourself reading about diarrhea at 3 a.m., you know you have found something you’re really drawn to.
And so after working on this essentially part-time, Holden — my co-founder — and I left Bridgewater and started GiveWell as a full-time project back in the summer of 2007.
Two things in there. One is the impulse to start looking for the effectiveness data on the charities you might support. Not to just say: We’re going to give the money to Doctors Without Borders, we’re going to give it to UNICEF. There are big charities out there. We’ve all heard of them. There was Charity Navigator, which is something that I used when I was younger.
What happened, what did you see, when you began looking?
We just started asking some really basic questions, and the answers we got back were shocking.
We each researched a different cause. I decided to research the cause of water in Africa. First we looked at Charity Navigator. At the time, Charity Navigator essentially just reported financial metrics. So it said: This is the amount of money that’s spent on overhead versus programs and fund-raising. And while this measure can tell you whether a charity is a scam or not, it’s not going to tell you whether the program is actually working.
Let’s say the charity spends all its money digging wells, but those wells disappear a year later and fall into disrepair. Well, that’s not a very effective use of funds, even if all of it was spent on programs.
So I called up the organizations and asked them: So what do you do? What do I get if I give you money?
And they said: Twenty dollars provides a child water for life.
Great! That’s amazing. I would love to give to that. But what do you mean? How does that work exactly? What does it pay for, and how do you know?
At that point, it’s like the conversation fell flat. They just didn’t have answers. What they actually said was: We don’t get questions like these from our million-dollar donors.
And this lightbulb went off: Almost no one was asking these questions.
Were they annoyed by you?
Some of them were annoyed by us. One organization accused Holden of being a spy for a rival organization. He had asked: How much money do you spend in each country? And they could only imagine that question would be asked if he had some nefarious purpose.
So I think they were annoyed. I mean, we were — what? — 25 at the time, so I’m sure we were annoying. But we really saw how neglected this area was, and it really motivated us to start GiveWell.
What’s striking to me about the way you approached it is that you even had the intuition that maybe you would give to a charity, and that what you were doing was making a bet in the same way as when you’re trading.
When you’re trading, the bet is supposed to make you money. When you’re giving to a charity, it’s supposed to improve lives.
In some ways, this basic question of: What is true? How can we know that it’s true? How can we assess the empirical data and evidence that we have to make the best decisions?
That’s exactly what GiveWell does in a very different way, in a very different context. But it’s bringing that same commitment to rigor and truth seeking to bear on trying to answer questions about what we should do in the world.
What are the things that, in your view, most commonly stand in the way of organizations — or for that matter, individuals — that care deeply about their mission or have skin in the game — financial or otherwise — from finding truthful answers?
I think there are two big things that happen, and there are many more that are downstream.
The first is, as an individual running an organization, you have an incentive for your organization to succeed. It’s very difficult to look for information that would mean your organization is not succeeding or shouldn’t receive money.
It’s not realistic to expect someone who, say, is running an organization that delivers food in a way that is very cost inefficient to determine that they should shut that program down and move on to something else. That’s just not how human beings operate. And I think that’s completely understandable.
The second challenge is that in order to make good decisions about where to put money, it’s very helpful to have a broad perspective. If you’re focused on, let’s just say, an inefficient delivery of food aid, you’re not going to be thinking about the role that a malaria vaccine could now have and whether you should be, in fact, delivering malaria vaccines instead of delivering food aid.
So I just think the place that most people sit in, let’s call it, the nonprofit economy, makes it implausible that they would take this kind of perspective.
I think that when I was younger and giving to charity, I didn’t really think at all about the idea that the money could fail.
I mean, these are good people. They’re trying to do something hard. They’re out there working on the ground. So it didn’t really occur to me early on that you might just give money to some of them, and that money would be useless.
What was the intuition that led you to treat money given to charity as money that could fail?
I don’t know what led us to have that realization. What I remember is it was at a time when you would go to CNET on the internet for ratings of printers if you wanted to know which printer to buy. And it almost seemed intuitive that you should be able to get the same kind of information about any way that you would spend money, including about charitable organizations.
In many ways, that was the initial vision for GiveWell, which we’ve evolved far from. But the initial vision was a place that donors could go and get information that is as good about where they’ll give as they could get at the time about which computer to purchase or which printer to buy. And it just seemed offensive in some ways that it didn’t exist for charitable organizations.
I think a lot of the focus that people bring to charity is on the donor. It’s saying to the donor: You should be generous. And when you are generous, that’s success.
But what that misses is that the person you should ultimately be focused on is helping someone in need. That’s the goal.
What is really important to remember is both the fact that you can fail to help the person in need, and that happens all the time, but also that charitable giving isn’t just a nice thing that a donor can do. It’s a very practical way to make the world a better place — that you can give and save lives.
And this has been clear and demonstrable, that supporting public health programs has this kind of impact.
That point about the focus being on the donor is interesting.
In the Jewish tradition, which you and I share, there’s this idea of tzedakah. I remember being in Hebrew school when I was young, going around with a little tzedakah box and collecting coins — I think it went to, at that time, UNICEF — and being taught that there were different levels of tzedakah. The highest level was when nobody knew you gave, and you did not know who you gave to, because that level was selfless in both directions. You were not expecting gratitude, you were not expecting prestige.
I do wonder if some of it comes from the history of charity and generosity as, among other things, a spiritual practice. You’re trying to develop a certain facility inside yourself as a virtuous and spiritually alive person. The idea that you’d be coming behind that money and checking up on it, I think, would be seen in some ways as in tension with the attributes you’re trying to cultivate.
When the focus of charitable giving is on the generosity of the donor, then that framework makes sense. And then there’s this alternative way of seeing the world, which I think is more intuitive to us in modern times than perhaps it was 3,000 years ago, that says: We know that we can make the world a better place.
The world is a much better place, in my opinion, today than it was 3,000 years ago. We do that via improved technology. We argue about the best political systems and what policies we should have. And now the argument that I’d like to bring forward is that charitable giving is one more way that each of us can take action and make the world better.
When you see it from that perspective, it’s critical to think about the effects that the programs have, where you can get as much impact as possible and also how to avoid failure.
So you and Holden split off from Bridgewater. You create GiveWell. You begin trying to gather this data, and trying to figure out even how you would make recommendations. How do you start?
The idea we had was that when we were individuals giving a few thousand dollars, it was hard to get information, but with some of the funds that we put together to start GiveWell full-time, heavily from our former co-workers at Bridgewater, we could incentivize organizations to share data.
We started by offering small grants that organizations applied for. I think at the time we offered several $25,000 grants, and organizations would send us data.
What we learned in that first year, after we recommended our first round of organizations, is that while we needed some data from organizations, what was really critical in pushing us to make recommendations was this huge trove of academic information about what works to help people overseas.
So these are often rigorous randomized controlled trials of health programs like distributing mosquito nets or provision of needed vaccines.
Who are these academics doing this work? Because on some level, it’s weird work to do to say to yourself: Well, I’m going to see if giving a family a cow really does help them in five years.
Where is this early evidence coming from, and what kinds of weirdos are collecting it?
There are different fields whose information we rely on. One is the public health field — so people asking questions like: How effective are mosquito nets? Or what impact will we get from vitamin A supplements delivered to young children? This is coming out of public health.
I remember actually speaking to one of these malaria researchers, who told me at one point early in his career, he had sat on the beach in Tanzania and just let mosquitoes bite him because they had to count how many bites he would get in some amount of time sitting on the beach. So certainly, they’re people who were themselves willing to go to great lengths and risk personal harm to create the information we rely on.
And then, separately, there is a movement in development economics around randomized control trials, where people are trying to assess not just the health effects of programs, which are often more easily measurable, but the economic effects of programs like microfinance or provision of livestock, or even just giving people cash to let them spend how they want. This movement in the 1990s and early 2000s, in many ways, I think of as being an intellectual forebear to GiveWell. We’re in our debt to all the work they did because they really helped generate many of the ideas that we’ve taken forward.
How do you think about freeing yourself from the very natural human tendency to think along with your group?
I find that people in finance or venture capital tend to be trained to look for places where the consensus might be wrong.
At the hedge fund level, if you only think what everyone else thinks, you’re not going to make money. But I think there’s also this dimension — and I feel like this is important to the work you end up doing at GiveWell — where there are things that are comfortable to think: stories we like to tell ourselves or are moved by and the way in which we can get wrapped up in those more emotionally driven approaches or socially driven approaches. You know: Everybody like you supports this charity. Or: Everybody like you knows that the economy is going to be bad next year.
The ask that I would make of most people is not to try to break away from the norm in an extreme way.
Instead, there’s this traditional idea — that I have, that many have — of giving 10 percent of your income to charity.
A very old religious idea — tithing.
So it’s not giving 90 percent or even 50 percent — it’s 10 percent.
In the same way, if someone is supporting local causes, if they’re supporting programs that are meaningful to them, one step to take is just move away by 10 percent, and move toward, if you want, the causes that we focus on — helping some of the poorest people in the world — with 10 percent of your focus and energy. And I think that 10 percent move is one that is available to many people.
So you’re pointing toward a very particular intuition people have, which is that we all get wrapped up in local causes.
And I want to say that for my giving, I give to a couple of different buckets. One is very local. I believe I have a particular responsibility to the community I am part of.
But there’s a tendency for the stories that you know and that are near you, and the people who know you tell you, to overwhelm the diffuse questions of global malaria or vitamin deficiency.
How did you travel that path? Because my understanding is that you began locally, as well.
When we started, we were based in New York. Now we’re based in the Bay Area, but we were looking at both causes focused on New York and causes focused overseas. I think the first donation I ever gave was to a New York-based organization called the Harlem Children’s Zone, a well-known local organization helping disadvantaged children in the New York City area.
What we learned after that first year of work at GiveWell was just how far a dollar can go overseas. In some ways we know this, but I think it’s a little bit of a figment of our imagination that the people we see every day are really closer to us in some way.
Last summer I traveled to Malawi, and this was just to see the types of programs we support, to speak with people who are there. And they’re far away, it’s true.
But with 36 hours of flying, I can sit as close to them as I’m sitting to you and ask them about their lives, what they’re struggling with, what they’re dealing with. And in the same way that at home I can see someone who’s in need, in sitting across from someone in Malawi, I hear about their struggle to have food, the days they went without eating, the mother who tried to bring her child to the local clinic, but she had to carry her child for an hour on her back, and then the clinic didn’t even have the drugs in stock.
I can also talk to the parents who — in maybe a way that’s very familiar to me, maybe to you — are struggling with the new second grade math book because they’re teaching arithmetic in a different way now in Malawi schools than they did when she grew up. So she doesn’t know how to help her child with the math because it’s different than what she did.
On one hand, there’s the analytical argument that a dollar goes farther. And then there’s just the reality that people in Africa aren’t as far away as we sometimes think. They’re really there — you can go and talk to them.
I think it is profoundly difficult as a human being to live as if other people’s lives are as real and as valuable as your own. There is a vividness to us and the people right around us — I don’t mean necessarily in our community, but our family, our friends, people whose stories interweave with our own.
To really treat people farther from that — somebody fleeing from gang violence in Honduras or somebody struggling at subsistence-level labor in another country — as if their life is as real as yours, and to really believe that, not just say it — in some ways I don’t think human beings are wired for that. But it does strike me as a genuine emotional and spiritual challenge.
I’m not sure that’s what we should be really aiming for, because I don’t think it’s possible. If we felt like other people’s lives were as important as our own, we wouldn’t be talking about giving 10 percent — we’d be giving far more.
In the same way, I don’t think it’s reasonable to expect or even want parents to treat their children equally to all other children in the world.
Would we want a society where all parents think of their own children exactly the same way as every other? I don’t think that’s a realistic expectation.
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No, that would be inhuman.
Well, quite literally. So I think sometimes the ideas that come from people who say you can give more and there are needs overseas, it sounds like someone is saying: You must, or you are bad if you don’t, or you should give everything away — because look at the great need.
And in some way, we must accept that’s true to some extent. But more practically, I don’t think that’s the right target to shoot for.
In my experience, people who try to aim at the target — which is treating others exactly like yourself or giving everything away to bring yourself down to the global median income — that maybe succeeds in the short term, but it certainly is not a long-term path to helping others as much as possible.
I’m always struck by how few charities actually make it into your top charities, and it has been fairly stable for some years now.
So walk me through what they are and what makes you confident in them.
Let me first frame up how the top charities fit into our overall work.
In 2025, we’ve directed funds to 70 organizations. Four of them are our top charities, and then there are more than 60 others that have received a lot of money. Perhaps they’re newer or our knowledge of the program is newer or the evidence is slightly more complicated and there’s a higher risk that the program fails — but if it works, it will be incredibly successful. So we direct a lot of funds to those types of programs, too.
What these top charities represent, to maybe use the finance analogy, is something like the blue-chip programs — the ones that have the strongest combination of evidence and track record and data behind them, so that we can say to anyone: If you’re trying to help people overseas, these are really great places to give to.
One of our top charities is the Against Malaria Foundation, which funds malaria-net distributions globally. The second one also works on malaria prevention, and that’s Malaria Consortium. In its seasonal malaria chemoprevention program, it provides seasonal anti-malarial medication to children during the malaria high season to prevent cases of malaria and resulting deaths. Another one is Helen Keller International, which focuses on provision of vitamin A supplements twice a year to children between the ages of 6 months and 5 years. And then the fourth is called New Incentives, and they deliver cash incentives to caregivers to encourage them to come to clinics to receive necessary childhood immunizations.
Those four, I wouldn’t call them the best. There are other programs we’ve recommended outside of those for water and malnutrition prevention and the malaria vaccine, which is relatively new — it’s not going to get on our top charities list yet — but there’s just this wide array of programs that help people around the world.
So this gets at the fact that there are multiple ways to donate through GiveWell. Walk me through those and how they relate to this division you’re making here.
Well, first, anyone can use our research for free. So anyone can come to our website, read it, and donate to any of the organizations that you see on our top charities list directly, without ever telling GiveWell that you’ve done it. And we hope you do, because that helps us understand our impact.
The primary options we offer people are, first, to give to our Top Charities Fund. Those are donations that we’ll only give to those four organizations based on the needs they have at the time we receive the funds. We push that money out the door. We commit those funds to organizations relatively quickly.
The next option for donors is to support the All Grants Fund. That just gives us the flexibility to give to either top charities or any of the organizations or programs that we might support, including giving money to help organizations or programs get off the ground or funding the type of research that we need to make our decisions.
And then finally, there are donors who give unrestricted. That is, in some sense, the highest level of trust in GiveWell, because you’re allowing us to decide how much we need to allocate to our own operating expense, versus allocating funds to the programs we support. We’ve been fortunate enough in the last few years that we’ve raised more unrestricted funds than we need for our own operations, and we’ve then designated that money for granting and sent it out the door to get it to people who need it around the world.
The most common critique I hear of GiveWell — one I even somewhat believe — is that there’s a limit to what can be measured. Measuring the effects of vitamin A supplementation can be like measuring the effects of funding for political change or fortifying public health infrastructure or climate change: It’s very, very hard.
How do you think about that question of what you can and cannot measure, knowing that much that cannot be measured is going to be important in human flourishing?
It’s a great question. To start, I think it’s really important to have humility in this work — that we can be wrong, and we know we can be wrong. There are times when we’ve supported programs that seemed like they would clearly be effective, and then at the same time, we also funded a rigorous randomized controlled trial to go along with that program.
There’s a program called No Lean Season that we helped start, and you can read all about it on our website if you’re interested. That program provided small cash incentives to encourage people to migrate from the rural areas of Bangladesh during the lean season to the cities so that they could earn more money and send money back home.
There was a series of randomized controlled trials that preceded our support of it that showed that it was having this effect. People were earning more money, they were even more likely to migrate in future years. Then we provided funding to start up this program with an R.C.T. — randomized controlled trial — alongside it. And, at scale, it didn’t have the effects that we expected.
Why do you think that is?
There’s just this big challenge of going from a 2,000-person research study to a 100,000-person program that exists in the world.
I think what may have happened in this case — and this is what I heard from the lead researcher of that program, Mushfiq Mobarak, a great academic — is that when they decided to deliver these cash incentives, they did it via microfinance institutions, essentially banks, that were there in Bangladesh. The loan officers who were delivering these incentives, which were small loans at the time — their personal incentive was to find the people who were already likely to migrate because that made their job of finding people to take these incentives much easier.
We decided to no longer continue supporting it. Evidence Action, the organization that implemented it, shut it down. That was a joint decision at the time. And I’m not even sure that decision was right, because it’s possible that with more time, we would have been able to solve this implementation challenge.
But this story just illustrates how critical measurement is. Measurement is certainly limiting. But I think when you’re trying to help people living 10,000 miles away, it’s just necessary to find some mechanism for getting feedback, to be part of a feedback loop that tells you if your bets are right.
Hearing that story, there’s some way in which I feel the danger of being a donor. Because if I had donated to that — which probably I did, because I’ve been donating through GiveWell for a long time — it would never occur to me to think: Maybe it’s not working.
It makes you wonder how much money out there is being wasted or if there’s something wrong with the studies — which I think is another question.
But you can’t subject every project to the rigor of expensive randomized controlled trials. So do you have concerns that you might be discarding things that actually work or that work in ways that you’re not measuring or that you’re not measuring for long enough, etc.?
What we try to do is find ways to build in a feedback loop so we learn something, and we can update our predictions about the future based on the reality of what occurs. Sometimes that’s a randomized controlled trial. It’s a great way to do it.
Other times — we supported a program, and we still do, that helped countries around the world transition from a single H.I.V. test and syphilis test — two individual products that were given to women who came into antenatal appointments — to a dual test. The idea was: If we can transition from having to apply two tests and two products to one, we can reach more people.
I think this program has been very effective — and very cost effective. We don’t know that from randomized controlled trial data. Instead, we know that from more programmatic follow-up about monitoring the data that comes from people who are going to antenatal visits, from seeing the stock levels of these tests in countries.
Ultimately, we wish it were the case that you could have a randomized control trial for everything, and we could push in the direction of greater certainty. It’s clear that there are so many programs that could be so valuable that just can’t be subjected to that level of scrutiny.
We can see today programs like people who scaled up H.I.V. treatment in Africa in the early 2000s, whether that was advocacy to the U.S. government or the philanthropic work that supported a 10-fold reduction in drug prices, maybe even a 100-fold reduction in drug prices, from some original levels. Those are incredibly impactful programs. With hindsight, we can look back and say those programs saved a lot of lives per dollar.
So I’m always trying to challenge researchers internally at GiveWell: When are we inappropriately prioritizing certainty and measurability over expected impact?
What are the areas or the charities that you think have either the highest expected impact or — maybe more relevant for this — the highest possible impact, but you just can’t measure it?
And I’m thinking here in the present, not doing long-termism and trying to save society 10 billion years from now.
What are the things that feel the riskiest to you in terms of they may not pay off, but maybe they do pay off and it’s worth it for that reason?
Let me give a couple of different kinds of examples because I think the spectrum of potential impact, but also risk, is very wide.
One example is a program we’ve recommended for a long time, which is treating children for parasitic infections. Often this goes by the name deworming.
The reason there’s so much uncertainty is that we have a single randomized control trial from about 30 years ago in one area of Kenya where they treated kids who had very high worm infections, followed them for many years. They’re still following them today — it’s really an incredible study. And we see that the kids who were treated as part of that experiment have much higher earnings today than the control group. This is one very strong piece of evidence.
There’s also evidence of improved weight gain from pooling multiple randomized trials, and some evidence from the American South when hookworm was eradicated here in the early 20th century.
But at the same time, I don’t think any of us would see that as clear knockdown evidence of a significant effect. The public health community says these trials don’t meet our standards for rigor. We’re not convinced by these results.
The worm levels today in 2025 are very different than they were at times in the past when these studies were implemented. And, at the same time, it’s so cheap to treat a child for parasitic infections. We know that these parasitic infections are bad. So this is one example of a program that may have an absolutely massive impact.
But I’m asking you to answer in terms of something bigger than that because you went to something where there’s an incredibly clear, specific causal mechanism.
The reason I’m fairly comfortable with deworming is the medicine works. You know what you’re funding there. There are a lot of other kinds of interventions — democracy promotion, for example. We don’t know if they really work, but if they work, they’re transformative.
What do you think about in terms of something where we can’t measure it, but maybe there’s a case for it? Not in the way that you’re just trying to figure out the magnitude of the impact of deworming, but something where you can’t figure out the magnitude of the impact — and you know you can’t?
A couple years ago, we made a grant to support Our World in Data. They’re a website that provides amazing information on problems facing the world. As someone who, 20 years ago, tried to find good data on problems in global health and development, I wish that a site like Our World in Data had existed then — because I know how hard it is to download multiple spreadsheets and match them up.
I talked to their founder Max Roser, and he was telling me that they were facing a challenge in raising operational funding. So we made a grant to them out of our All Grants Fund. We can’t measure what effect that had, but that’s a site that, in aggregate, has so much impact.
Another example is a grant that we made this past year in response to the U.S.A.I.D. cuts. We supported, essentially, consulting units at two organizations, one called Clinton Health Access Initiative (CHAI) and one called PATH, that would work closely with governments to plan their response to the aid cuts, to understand where they had gaps that needed to be filled, even to articulate the funding needs that they had so they could potentially raise money from other donors.
But that support to government decision-making is something that clearly could be incredibly impactful on helping people in those countries. But we don’t have a quantitative estimate of what’s accomplished because of that.
You don’t just subject charities to the binary question of: Does it work or does it not work?
You have a certain measure of cost effectiveness it has to clear. Working is not enough. It has to be cost effective compared to other interventions.
Tell me about your measure of cost effectiveness.
I’ll just use the cost-per-death-averted metric as a simplified way of putting this. We do try to look at the effects that come from improved health, increased income, to some extent increased well-being and put it all into one measure that we can use to compare across programs. Of course, that is incredibly subjective, but nevertheless, as we’re trying to look across programs, we have it.
What we aim to do is say: If you could use $60,000 to avert the deaths of 10 children, that’s a much better decision than using that same amount of money to avert the death of only one child. It’s better to use the resources you have to help people to a greater extent.
How do you weigh things against each other that are not the same thing?
I mean this on two levels. One: There’s a question of lives saved versus income versus: What’s the value of not suffering from an illness that doesn’t kill you? Or: What’s the value of an education?
And then there’s also the way in which different people just weight different moral questions differently.
I know you all have put a ton of work into this. How do you try to do that? How do you both try to standardize the first set of questions? And then how do you try to create space for the different ways different donors might think about what is important?
The starting point for us is that, in many cases, donors come to us, and they essentially say: We want you, GiveWell, to decide where and how to allocate our funds.
Because of that, we’re responsible for making these decisions about how to weigh different kinds of good against each other.
To do that, we’re trying, as we often do, to collect the information we can and then just make the best judgments that we’re able to with that information.
So we look at academic research. For example, in trying to weigh things like income against health, there are academic studies that look at the value of a statistical life, and we’re trying to use that data to the extent we can.
We also try to survey our donor community and understand the preferences that they have collectively.
We’ve also tried — and have funded some studies in Africa — asking people how they would make these same choices and trade-offs.
All of this is very challenging. I would not claim that it is in any way getting us closer to truth, but it’s the mechanism that we use to try to make these decisions.
Importantly, I’m certainly not trying to say that our answer is correct. Instead, GiveWell fills an important part of the donation ecosystem, where we’re trying to be almost like the economists’ approach to giving overseas, and we’re just trying to do that as well as we can. And of course, there are many other ways and many other approaches that people could take.
So GiveDirectly is a program where you give the organization money, and they give the money to other people. The idea is that people know best how to spend the money in their own lives.
Very controversially, a few years ago, you stopped recommending GiveDirectly. That’s a group I still support. I’m a believer in their work. And that was very controversial because your argument was not that it’s not doing what it says it’s doing, or even that it’s not good for people to get money.
So what is the line for you, and how do you think about some of the things that fall beneath it, because they’re not primarily about saving lives but about changing incomes or changing health or improving lives?
I should say I’m also a huge fan of GiveDirectly. I’m still personally a donor to GiveDirectly. I think the work that they do is amazing and wonderful.
The reason that GiveWell doesn’t recommend funds to GiveDirectly now is that, roughly speaking, we think the organizations we’re supporting are able to do three times as much good per dollar as a dollar to GiveDirectly right now.
Because of that, we feel like we’re faced with the question: With limited resources, where should we give?
Especially now, when resources are lower than they’ve been in many years because of cuts in U.S. foreign assistance, we just think it’s all the more important to try to allocate resources where they’ll do the most.
That doesn’t mean that the organizations we’re not supporting aren’t doing good work or that they’re failing in some ways. It just means with the limited resources we have, we’d like to see them go as far as they can.
GiveWell has an unusual relationship to transparency and to being pretty open about mistakes. If you go to the GiveWell website, you can click on a tab that says “Our Mistakes” and read a ton about things you’ve gotten wrong, what has happened and places where you’ve erred.
In almost everything you do, there’s a section on doubts and uncertainties. Tell me a bit about that approach. What have been your biggest mistakes?
We’ve made a lot of mistakes over the years, both in terms of specific organizations we’ve recommended and methodological approaches we’ve taken.
Just one example: For a long time, we were relying primarily on one data source to estimate mortality from diseases in countries. More recently, when we went and collected more data sources, and we saw how different they could be and the effect that those different sources of data about the causes of mortality could have on our ultimate recommendations. So that’s just a pretty significant mistake that we corrected in the last few years.
I think transparency is so important because charitable giving isn’t like solving a math problem where you can just say: I know the right answer. I’ve proven it, and therefore you should listen to me.
Instead, there are huge amounts of judgment and values that go into the decisions that we’re making. So first, we think it’s important for the people using our work to be in a position to understand it and judge it for themselves, to know that others have evaluated our work and looked at it critically.
I also think it plays an important role in holding us accountable internally, because every single decision that we make about how to spend money can be subjected to public scrutiny.
Trump took office not even a year ago — it’s been a long year. Very soon after, his administration decapitated U.S.A.I.D. and cut foreign aid in a number of other domains and directions.
Almost a year later, how much less foreign aid is the United States government giving? And how has the composition of what we’re giving changed?
There’s still a lot that we don’t know. The U.S. government previously was giving about $12 billion a year to global health programs, and we think there might end up being about a 50 percent cut in total U.S. government giving.
So that would be a whole of $6 billion going to global health programs. This is a large portion of aid going to health around the world because the U.S. government accounted for about 20 percent of total global health aid. So $6 billion — or 10 percent of what was going to support these programs — may be disappearing.
We’ve seen plenty of great programs that needed money that weren’t getting them — programs that provide basic health services, like malnutrition treatment and malaria control. So in response to the cuts this year, we directed about $40 million to programs where we were in a position to step in.
Just as another example: When I was in Malawi this past summer, I talked to clinicians and the hospital administrators about their experience responding to aid cuts. For them, some of the biggest cuts that they felt immediately were in H.I.V. treatment because the U.S. government has such a large H.I.V. program.
One hospital administrator there told me this story: On the day of the cuts, it was 9 a.m., they had all come to work. There were patients lining up outside to get the treatment they had come for. The facility staff were called into a staff meeting and just told to go home immediately.
So you had these patients lining up and no staff to give them their medicine. Many people travel from miles and miles away because they’d rather pick up their H.I.V. treatment further from home. Because of the stigma of having H.I.V., they don’t want to be seen close to home getting their drugs.
Then the hospital had to bring in some of their limited staff from other departments and get them in place to try to deliver the AIDS treatment.
The way he told me the story is that they were looking at the pill boxes that a patient brought in and trying to match them to what was on the shelf, just to keep delivering what they had.
Similarly, I visited a small clinic in a more rural area. An important part of H.I.V. treatment is viral load testing. This is testing people to ensure that the treatment that they’re undertaking is preventing them from progressing to full-blown disease.
And viral load testing really stopped in early 2025. I was able to see this because we just pulled up the data on their computer screen, and we could see how they went from testing hundreds of people in a month to almost none following the cuts.
Are there significant areas where the money has been restored?
We’ve seen a lot of money come through in malaria. One of the programs we supported earlier this year was planning for these seasonal anti-malaria medication campaigns.
Basically, in certain parts of the world, malaria has a high season, and if we can provide children with anti-malarial medication during the high season, we reduce about 80 percent of the cases during that time of year. Those campaigns, I believe, were happening starting in June, and the planning had to happen in March, April and May. So, this was right after the cuts, and organizations didn’t know if they were going to have money to conduct planning.
We went to them and said: If the money doesn’t come through, we’ll cover it, and if it does, then we won’t have to. But you can go ahead knowing that you’ll have funding to cover what you need.
Ultimately, for many of those programs, the funding came back, and we didn’t have to spend a dollar to enable them to move ahead.
When you’ve looked at what has happened — and I’m not trying to get you to be political — have you seen a theory of foreign aid or simply a hostility to foreign aid?
We haven’t seen a lot of interest in trying to answer the question: What would great foreign aid look like?
If you go back to Jan. 15, there were plenty of people on both sides of the aisle saying that U.S.A.I.D. should be a lot better. There are a lot of ways that we can improve foreign aid.
There were some people I remember talking to before the cuts occurred who were excited about the possibility of a focus on efficiency in delivering outstanding, cost-effective foreign aid. And I just don’t think that’s what we’ve seen.
If somebody did come to you and say: Listen, we’re going to restore U.S.A.I.D. funding, but we want it to be better. We want our money to go as far as it possibly can. What does that theory of reform look like to you?
Two big pillars would be, first, focusing on the public health programs that we know how to deliver at scale, that we can deliver cost effectively at scale, that have significant impact. These are similar to the programs we’ve been discussing: H.I.V. treatment and prevention, malaria treatment and prevention, and more.
Then, I also think there’s a big place for just delivering cash directly to people who need it. At GiveWell’s margin, I think that we’re spending funds more cost effectively, but at large scale, I think cash is one of the most cost-effective ways to just let people make their own decisions about how to improve their own lives.
How about data? One thing that I’ve heard a lot of people worry about — and it seems to me like a particular problem for GiveWell, given how data-oriented you try to be — is that these cuts ravaged a lot of the surveys, data collection and studies that create the possibilities of this evidence and these feedback loops and being able to know for next year what would be better than what we did this year.
What has happened in that space? What is being done about it?
One of the most important tools that we and others rely on is something called the Demographic and Health Surveys, or D.H.S., that U.S.A.I.D. has funded for years.
These are large nationally representative surveys that inform people in positions like us, allocating money to low income countries but also country governments themselves.
So when they’re trying to answer the question: How many students are going to be in each district and therefore, how many schools and teachers do we need? — they’re often relying on this kind of data. This is one of the data sets that has gone away under the cuts that we observed.
These surveys are so critical that, in one way or another, I believe that some form of them will be preserved. It’s something that I know other funders have looked at, that we ourselves are considering. But it’s just so critical that this data continues to exist.
It’s undoubtedly been a big part of the challenge in understanding what has happened. A question that you asked that I get a lot is: What have the effects of the cuts been? Where has money gone and not gone? Where is it flowing and not? What has been the humanitarian impact?
But I think the true answer is: We don’t know. And some of that not knowing is a function of the data that we rely on being less available than it was before, and that makes the situation even more challenging.
You talked a bit about how you’ve directed $47 million around trying to fill some of these holes.
What has happened in the rest of the philanthropic space? You have foundations much bigger than GiveWell, like the Gates Foundation. You have other countries, European countries.
What is the landscape of players who could have possibly filled holes? How has the sector responded?
We’ve seen similar action from philanthropies trying to give what are large amounts of money in level terms — but certainly small relative to what governments were giving — allocate more in response. The big challenge that everyone recognizes is philanthropy is just very small compared to the level of giving that the U.S. government was providing.
Then at the same time, many countries around the world are also giving less. So, in aggregate, it seems like we’re entering a period where global foreign assistance, especially for health, will be lower than it has been in the recent past. So I hope that means that individual donors will step up and give more.
I also hope that it means — and we’ve seen some evidence of this — there will be a higher priority focused on using the limited resources we have as well as we possibly can. For a long time, we felt like ideas of cost effectiveness were not taken perhaps as seriously as you might expect in the world of global health and development.
But with more limited resources, there’s much more of a focus on taking what we have and trying to cause it to go as far as we can. That might mean allocating more funds toward Nigeria and the Democratic Republic of Congo for malaria because they account for 40 percent of the global malaria burden. I think we’ve seen a lot more interest behind those kinds of ideas.
Has this pullback in public health funding changed what you think will be the most effective opportunities for giving?
It certainly might, and here’s why: What we’re trying to do is deliver funds where they’ll be most cost effective at the present margin. Really what these cuts mean is that the margin has shifted.
One area that we never really looked at before was H.I.V., because it was extremely well-funded. We also made a grant to support an organization called ALIMA. This grant was primarily focused on enabling them to deliver primary health-care services and malnutrition treatment in a very challenging area of Cameroon. That’s another kind of work that had been previously more supported by government donors.
So as we look forward, we know that the changing level of funding just means that there are going to be all sorts of programs that we didn’t consider before that we’re going to have to look at because the underlying situation has changed.
Is lobbying on foreign aid, particularly paying Trump-associated lobbyists, maybe an effective use of charitable funding?
We’ve worked with an organization that’s just trying to inform people on the Hill about the facts of what can be achieved. You know much more than I do about what would be effective lobbying. But what I think we can bring to the table is just providing accurate information about what can be accomplished and hoping that decision makers will take that on board when they decide what to do.
One of the challenges for GiveWell and for this kind of giving is that giving often relies on an emotional hook for people. There’s charismatic megafauna in the philanthropic space — and then there’s this conversation about the cost effectiveness and the spillover benefits of deworming.
I can watch you trying to be objective about what you’re funding and the requirement that imposes on you to be serious about trade-offs in ways that are probably emotionally kind of hard. And on the other hand, giving is an emotional project. People give emotionally.
We could talk about randomized controlled trials all day and all night, but most people don’t get out of bed because they read an R.C.T.
So how do you reconnect those impulses running an organization that is so much about trying to correct for the biases our emotional drives might create for us?
First off, I think sometimes this argument can go too far. We all know that most people are giving based on a personal attachment.
When we were thinking about starting GiveWell, I just remember everyone told us: Donors don’t give this way. This is never going to work. What are you even trying?
Now, more than 18 years later, we have 100,000-plus donors who have used our research. We’ve directed more than $2 billion. So there are certainly a lot of donors and a lot of people who are excited to give this way.
Then when I think about how this all works, I’d say that the motivation to do this work comes from an emotional place. For me, sometimes that’s people I meet when I’ve traveled to Africa.
An experience I always have is I go to the pharmacy and I pick up amoxicillin for my kid who has an ear infection. It costs me 50 cents, and it literally takes me five minutes. I always think it’s so wild that I can just go to the store and pick up this amoxicillin like it’s nothing.
I remember that there was a time when GiveWell supported an organization to deliver amoxicillin to Tanzania because they were running low on amoxicillin stock, and they weren’t going to have amoxicillin in all the clinics around the world.
So, sure, we spend all our time talking about the data because it’s the data that helps us make the right decisions. But for me, and I think for everyone I work with, it’s just this knowledge that we’re in such a fortunate position, and there are so many people who aren’t in that position.
Sometimes we have to key in on individuals to focus our work, but ultimately what we want to do is just bring those benefits to as many people as we can.
Always our final question: What are three books you’d recommend to the audience?
One is “Factfulness” by the late Hans Rosling. This is a book that just brings global health data to the world. The core argument of the book is something like: In order to prioritize correctly, we need to understand the world accurately. Rosling’s site Gapminder was one of the things that got me very excited about this work back in 2006.
The second book is “Poor Economics” by Esther Duflo and Abhijit V. Banerjee. They’re two of the founding members of this randomized control trial movement in development economics. This book gives an overview of their work and the ideas behind this work and work that’s not just from them but from people like Michael Kremer, Rachel Glennerster, Dean Karlan, Edward Miguel. It really was just part of the animating values of what has led to GiveWell and our work.
Then, finally, a book called “Behind the Beautiful Forevers” by Katherine Boo. She spent years in Annawadi, India, an informal urban settlement, sometimes known as a slum, near the Mumbai airport. It just paints a very vivid picture of what life is like in poverty.
“Behind the Beautiful Forevers” is definitely in my top five pieces of nonfiction ever. If people have not read that, they really should.
Elie Hassenfeld, thank you very much.
Thank you.
You can listen to this conversation by following “The Ezra Klein Show” on the NYTimes app, Apple, Spotify, Amazon Music, YouTube, iHeartRadio or wherever you get your podcasts. View a list of book recommendations from our guests here.
This article is part of Times Opinion’s Giving Guide 2025. The author has no direct connection to the organizations mentioned. If you are interested in any organization mentioned in the guide, please go directly to its website. Neither the authors nor The Times will be able to address queries about the groups or facilitate donations.
This episode of “The Ezra Klein Show” was produced by Jack McCordick. Fact-checking by Michelle Harris, with Kate Sinclair. Our senior engineer is Jeff Geld, with additional mixing by Isaac Jones. Our executive producer is Claire Gordon. The show’s production team also includes Marie Cascione, Annie Galvin, Rollin Hu, Kristin Lin, Emma Kehlbeck, Marina King and Jan Kobal. Original music by Aman Sahota and Pat McCusker. Audience strategy by Kristina Samulewski and Shannon Busta. The director of New York Times Opinion Audio is Annie-Rose Strasser. Transcript editing by Andrea Gutierrez, Sarah Murphy and Marlaine Glicksman.
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