Bridging an Uncertain Time for a Lifesaving Program: November 20, 2025

Nov 20, 2025

Natalie Crispin, a seasoned program officer at GiveWell, shares her insights on the crucial Seasonal Malaria Chemoprevention (SMC) program. She discusses the impact of recent foreign aid cuts and the urgent need for careful planning to deliver antimalarial medications to vulnerable children. Natalie explains the logistical challenges of coordinating across multiple countries and the flexibility of funding mechanisms that allowed campaigns to proceed despite disruptions. The conversation highlights the program's effectiveness, with significant lives saved per dollar spent.

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INSIGHT

SMC Operates At Massive Scale

SMC reaches tens of millions of children annually and is logistically massive across many countries.
Successful campaigns require precise drug allocation and well-trained staff for door-to-door delivery.

ANECDOTE

Flexible Guarantees To Bridge Uncertainty

GiveWell considered loan, guarantee, or upfront payment structures and chose guaranteed monthly disbursements during the planning period.
Organizations confirmed each month whether U.S. government funding had resumed so unused funds could be conserved.

INSIGHT

Small Commitments, Large Leverage

GiveWell committed about $8 million in guarantees across six country programs but spent roughly $4 million.
Much funding wasn't paid out because U.S. government support resumed for many programs.

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Despite significant progress over the past several decades, malaria remains a leading cause of death globally for children under five. This year’s cuts to foreign aid funding disrupted highly effective programs to prevent malaria, such as seasonal malaria chemoprevention (SMC).

SMC provides antimalarial medication to children under the age of five during the rainy season when malaria transmission is highest, reducing their risk of dying from the disease. Malaria Consortium’s SMC program, which is one of the most cost-effective programs our researchers have identified, has been one of GiveWell’s Top Charities since 2016, and we’ve recommended more than $500 million in grants for the program since that time.

SMC is only delivered during a specific period each year when malaria transmission is highest. The campaigns require careful planning and preparation on a specified timeline to ensure that the drugs are ready to distribute during that window. The funding freeze that started in January jeopardized 2025 SMC campaigns in several countries because of the disruption to funding for these time-sensitive pre-campaign activities.

In this episode, GiveWell CEO and co-founder Elie Hassenfeld speaks with Program Officer Natalie Crispin about how GiveWell responded quickly and flexibly to ensure that SMC campaigns moved forward this year.

Elie and Natalie discuss:

Planning for SMC campaigns: Prior to carrying out SMC campaigns, implementing organizations engage in an intensive and time-sensitive planning process to ensure that drug distributors are fully trained, the right quantity of preventive drugs is shipped to each community, and people are informed about upcoming campaigns.
GiveWell’s response to keep SMC campaigns on track: GiveWell considered funding for SMC in 11 countries where it had been funded by the US government, talked with stakeholders in 10, and ultimately provided funding guarantees for SMC planning activities in six countries. These grants ensured funding for pre-campaign activities if US government funds didn’t return—enabling implementing organizations to move forward with timely preparations while their funding was uncertain.
Challenges, reflections, and lessons learned: While the work required for us to decide whether, when, and how to provide funding was more time-consuming than many of our grants, it strengthened our networks among SMC implementers and funders, and we believe our funding guarantees made a difference in ensuring that the campaigns were able to be carried out.

GiveWell has a long history of finding and funding highly cost-effective malaria programs. Our prior work on SMC enabled us to move quickly to protect lifesaving programs and keep campaigns on track until US government funding was restored.

Visit our Foreign Aid Funding Cuts webpage to learn more about our response and how you can help, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on November 17, 2025 and represents our best understanding at that time.