Interview, Fireside Chat
How to improve global health and wellbeing in clear, direct ways | Alexander Berger
- Open Philanthropy's Portfolio Split: The organization divides its grantmaking into two primary umbrellas: "Global Health and Well-Being" (led by co-CEO Alexander Berger) and "Long-Termism" (led by co-CEO Holden Karnofsky), aiming to allocate approximately 50% of resources to each, with a potential range of 30-70% depending on opportunity sets.
- Naming Convention Shift: Open Philanthropy explicitly named its non-long-termist work "Global Health and Well-Being" to move away from the contrastive and potentially pejorative term "near-termism," focusing instead on the substantive goal of maximizing current well-being rather than just the immediacy of impact.
- Current Grant Allocation: Historically, "GiveWell Top Charities" (e.g., distributing insecticide-treated bed nets via the Against Malaria Foundation) have comprised roughly 50% of the Global Health and Well-Being portfolio, leveraging a ~100x cost-effectiveness advantage of transferring wealth to the global poor versus the average wealthy donor.
- New Cause Areas: Open Philanthropy is actively expanding into South Asian air quality (estimating a loss of nearly 3% of global life-years lost to air pollution in India) and global aid advocacy (seeking to leverage funding to increase foreign aid volumes from wealthy nations).
- Hiring Initiatives: The organization is hiring for three key roles: a lead for the South Asian Air Quality program (requiring policy/India experience), a lead for Global Aid Advocacy (requiring broad advocacy experience), and two "Cause Prioritization" team roles (one research-focused, one strategy-focused) to identify future high-impact causes.
- Epistemic Modesty: Berger argues that "Global Health and Well-Being" relies on "cluster thinking" (weighing multiple heuristics and outside views) rather than "sequence thinking" (linear, high-confidence mathematical models), acknowledging high uncertainty in long-term predictions.
- Sign Uncertainty in Long-Termism: A primary argument for diversifying into Global Health is "sign uncertainty," where long-termist interventions (e.g., raising salience of AI risk) could theoretically increase existential threats or accelerate dangerous technologies, making bets on concrete, immediate impact safer.
- Feedback Loops: Concrete causes like bed net distribution and cage-free campaigns provide immediate, observable feedback loops that allow for rapid iteration and scaling, whereas long-term interventions often lack measurable intermediate progress to validate the causal chain.
- Diminishing Returns on Scale: Berger notes that while science and policy advocacy can offer high leverage, they often struggle to absorb billions of dollars at the same cost-effectiveness as top charities due to steeply declining marginal returns and the difficulty of scaling interventions to match Open Philanthropy's $200M+ annual giving capacity.
- Kidney Donation: Berger donated a kidney to a stranger in 2011, citing a risk of death in surgery of roughly 1 in 3,000, with long-term health risks estimated at ~1%; he advocates for legalizing and compensating kidney donation to save lives and reduce government healthcare costs.
- Bioethics Stance: Berger strongly criticizes the moral intuitions against kidney markets, arguing that opposition is largely based on "disgust" rather than rigorous cost-benefit analysis, and that a regulated compensation system could save hundreds of thousands of lives globally while generating net savings for healthcare systems.
- Worldview Diversification: Open Philanthropy allocates resources across human health, animal welfare, and long-termism not just for expected value, but to hedge against philosophical uncertainty (e.g., totalism vs. person-affecting views) and to avoid "fanaticism" that could arise from betting everything on a single moral framework.
- Career vs. Grantmaking: Berger distinguishes between career advice and grantmaking, suggesting that while individuals might take high-risk, long-term bets (like AI safety) where they can build deep expertise over 40 years, institutional grantmaking must prioritize scalable, observable impact to avoid funding neutral or harmful activities.
- GiveWell's Edge: Berger defends the ~10x cost-effectiveness advantage of GiveWell's top charities over cash transfers, arguing that beneficiaries (often children) cannot make complex value calculations, and that bed nets provide significant positive externalities (killing mosquitoes) that cash transfers do not.
- Critique of "Broad Long-Termism": Berger is skeptical of "broad long-termist" causes like improving societal judgment or international relations, arguing that the causal chains connecting these abstract improvements to the far future are too tenuous to justify diverting resources from more concrete, evidence-backed interventions.
- Pandemic Preparedness Distinction: Long-termist biosecurity efforts focus on preventing pandemics 10-100 times worse than COVID-19, often deliberately avoiding interventions that address only the immediate threat (like specific COVID treatments) to prevent crowding out more neglected, high-stakes existential risk work.
- Economic Growth Debate: Open Philanthropy's cost-prioritization team is evaluating economic growth policies, finding them potentially comparable to top global health charities but not vastly superior, leading to a decision to treat growth as a complementary cause rather than a dominant one.
- Historical Context: Berger joined GiveWell in 2011 (when the team had ~5 employees), originally motivated by a desire to find the "best charity" after witnessing begging in India, and was hired after sending an email expressing his dream to join the organization.
- Community Sentiment: Berger observes that the effective altruism community is heavily concentrated on AI risk and bio-security, and that Open Philanthropy's diversification helps prevent over-reliance on narrow, unproven future narratives.