200,000 - 400,000

(This leverage factor is for grants to ACTION's US focused efforts, which requires making a grant agreement, and may not be something an individual can contribute to. An individual can contribute to ACTION more broadly (through a check to RESULTS Educational Fund with ACTION in the memo line), but it seems likely that some diffusion will occur as ACTION's non-US efforts likely have a lesser impact than their US efforts, perhaps 2-3 fold.)

This leverage factor, though large, appears plausible. Developing world health interventions typically seem to have leverage factors in the 2,000-10,000 range, and our lobbying and advocacy page suggests lobbying and advocacy may magnify the underlying leverage factor 20-40 fold.

This leverage factor may appear to rest in large part on ACTION's TB advocacy in 2007 and 2009, however ACTION's advocacy on TB is ongoing. Were it not for action against presidential budget cuts to TB funding in 2015 and 2017 the value of ACTION's earlier advocacy would be diminished. In other words it is the way we are scoring the advoacy not the advocacy itself that shows the results occuring only in 2007 and 2009.

Notes:

2017. The FY2018 presidential budget request included the following cuts: Global Fund for AIDS, TB, and Malaria $225m according to Kaiser Family Foundation ($100m according to RESULTS; KFF appears correct based on my reading of the Department of State FY2018 budget justification), Maternal and Child Health $65m ($815m in FY2017 according to Kaiser Family Foundation and RESULTS but no cut from FY2017 $750m based on my reading of budget justificaiton), Nutrition $46m, bilateral TB $62m, and cuts in other global health areas not advocated for by ACTION; no obvious offseting increases to other accounts; cuts largely blocked by Congress through the appropriations process; Global Fund takes the largest cut and other areas probably have a similar cost effectiveness; in 2013 analysis we estimated the Global Fund saves a life for every $1,600 spent; assume if past cuts would remain for 4 year presidential term; 4 x ($225m + $65m + $46m + $62m) = $1,590m in cuts; $1,590m / $1,600 = 1,000k lives saved; 1,000k x $2m = $2,000b.

2016. Global Fund FY2017-FY2019 authorization $4.30b, a 6% increase over the $4.05b appropriated in FY2014-FY2016, which just about keeps up with inflation.

2015. The FY2016 Presidential budget request included a $250m cut to the Global Fund, and a $45m to bilateral TB; these cuts were removed by Congress in the enacted budget; the cut to the Global Fund was a hard cut without any offseting increase in the State Department's Global Helath Programs account; estimate the cut would last for 2 years until a new presidential election; in 2013 analysis we estimated the Global Fund saves a life for every $1,600 spent; value of prevention of Global Fund cuts but not TB cuts as value of ongoing TB funding is captured in analysis of 2009; 2 x $250m / $1,600 = 310k lives saved; 310k x $2m = $630b.

2014. Only annual funding above a $150m baseline line is counted as an advocacy win; US funding for the pledged period of 2015-2018 has been $200m, $235m, $275m, *** $290m ***; a key funder of GAVI Alliance is the Bill and Melinda Gates Foundation, in 2010 they announced the Decade of Vaccines initiative which would save 8.7m children's lives for $10b, or one life for every $1,150 invested; ($50m + $85m + $125m + $140m) / $1,150 x $2.5m = $870b.

2013. ACTION helped secure a US pledge of $5b for FY2014-FY2016 to the Global Fund for AIDS, TB and Malaria (a $1b increase over the previous 3 year pledge); funding was not fully appropriated; funding was at this level and level with FY2013 for FY2014, but then dropped by $300m in FY2015-FY2016 with an offseting increase in the State Department bilateral Global Health Programs account; if the previous $4b authorization had existed an excess of $350m over the $4b would not have been able to be appropriated to the Global Fund; assume a counterfactual that this money would not have been spent anywhere near as effectively; the Global Fund Results Report 2017 reports 22 million lives saved by $32.6b disbursements and (eyeballing it) $2.8b operating expenses for 2002-2016; ($32.6b + $2.8b) / 22m = $1,600 per life saved; $350m / $1,600 = $220k lives saved; 220k x $2m = $440b.

2011. US funding to GAVI Alliance for 2007-2011 was $69.3m, $71.9m, $75.0m, $78.0m, $89.8m; only annual funding above a $100m trend line is counted as an advocacy win; US funding for the pledged period of 2012-2014 has been $130m, $138m, $175m; post pledge US funding increase has been re-appropriated and remained above $150m for the next *** 4 *** years; a key funder of GAVI Alliance is the Bill and Melinda Gates Foundation, in 2010 they announced the Decade of Vaccines initiative which would save 8.7m children's lives for $10b, or one life for every $1,150 invested; ($30m + $38m + $75m + 4 * $50m) / $1,150 x $2.5m = $310b; ACTION's role is a very rough estimate based on lack of awareness of any other key advocacy organizations being involved on this issue.

2010. Funds were pledged by the US for the Global Fund and appropriated over FY2011-FY2013 boosting Global Fund funding from $1.05b to $1.65b per year; however, the increase in Global Fund funding appears to be at the expense of the State Department's Global Health Programs account; in FY2010 Global Fund plus GHP was $5,614m; in FY2014 (FY2013 not used due to 5% sequestration) Global Fund plus GHP was $5,670m representing a slight net decrease after inflation; any advantage is thus a result of the Global Fund being more effective than the Department of State's GHP account.

2009. Funds appropriated in one year are likely to be re-appropriated in subsequent years, to account for this we multiply by the number of years the increase has been present (so far for 9 years), discounted at say 3% inflation, or 8.0 years; ideally we would add the number of additional years the increase persists, but this is unknown so we conservatively assume the increase is going to disappear next year; assume $17 per DALY saved per note on TB treatment; $50m x 8.0 / $26-69/DALY = 5.8-15.4m DALYs saved; 5.8-15.4m DALYs saved x $90k/DALY = $520b-1,380b.

2008. ACTION played a central role in achieving a major authorization of new TB funding -- $4 billion over five years, and a target of treating 4.5 million people with TB. While both authorization legislation and appropriation of funding are necessary for to support the programs for which ACTION advocates, only actual appropriation of funding is counted as success in our analysis.

2007. Funding in one year persists for multiple years (so far for 11 years), discounted at 3% inflation, or 9.5 years; assume $17 per DALY saved per note on TB treatment; $68m x 9.5 / $26-69/DALY = 9.4-24.8m DALYs saved; 9.4-24.8m DALYs saved x $90k/DALY = $840b-2,240b.

Note on TB treatment. We consider treatment of individuals with signs of TB in low income countries. WHO estimated 44% of global new TB cases were smear positive in 1997. The DCP3 reports first-line drug treatment of TB for smear positive cases as costing $6-49 per DALY saved, and $42-84 per DALY saved for smear negative cases. A weighted average cost is thus $26-69 per DALY saved.

Note on ACTION US budget estimates. It is simplest to evaluate ACTION's US work only, and to assume ACTION and its partners have similar successes elsewhere. ACTION's total US budget can be determined by subtracting from expenses the grants on RESULTS Educational Fund's IRS form 990 for the ACTION project. However much of this budget is for the ACTION Secretariat housed in the US, which supports all partner countries. Data supplied by ACTION for 2007-2010 and pre-liminary data supplied for 2012 indicates that the actual ACTION US budget comprising just US advocacy and the US fair share of the ACTION Secretariat is 12-30% of the ACTION total US budget. To be conservative we use the 30% value as the ACTION US budget estimate. 2014 IRS form 990 not available; budget estimate for 2014 based on 2014 budget value.

Note on chance would happen without advocacy. If I lack any specific insight into this, I use 50% as a default value.

Note on ACTION's advocacy role. ACTION's role estimates pre-2011 made in conjunction with ACTION.

Note on ACTION's value add. The economic value in Western terms is multiplied by 100% minus the chance outcome would happen without advocacy to give the advocacy value add. This is then multiplied by ACTION's advocacy role to get ACTION's value add.