GiveBetter x SF

New Incentives

Cash incentives for childhood vaccination in northern Nigeria

Research time: ~16 min on GPT-5.6 Sol Medium
  • Research — organization and evidence review.
  • Modeling — cost-effectiveness analysis.
  • Historical estimate for research done before time tracking.

Published: September 8, 2026.

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Summary

What do they do? New Incentives provides caregiver cash incentives, community awareness and vaccine-stock support alongside free government vaccination in northern Nigeria. More

Why this approach interests us

  • A randomized evaluation found higher vaccination coverage, and the core program is inexpensive relative to the consequences of preventable childhood disease.

Our main reservations

  • GiveWell's August 2026 summary uses 2022–24 grant-weighted funding opportunities. Applying that historical yield to an ordinary gift is our assumption, not a guaranteed offer or a verified price for today's next dollar. The native estimate already accounts for other funders' responses. Our QALY figures are not GiveWell's moral weights or its own QALY estimates.

What do you get for your dollar?

Our conditional best estimate is $3,870 per 10 global QALYs, or $387 per QALY. A representative ordinary gift is modeled at about $3,900 per 10 global QALYs. We assign 90% to the immunization core and use GiveWell's historical $4,500 per modeled life saved. We charge the full gift; the remaining 10% has unquantified health benefits, not assumed zero value. Inspect the current model. Original v1 model and scenarios.

global health
$3,870 — per 10 additional QALYs; whole-gift historical-benchmark scenario
bay area health
0% credited — No quantified direct local benefit; unknown spillovers are not relabeled global impact.

1. What do they do?

New Incentives provides caregiver cash incentives, community awareness and vaccine-stock support alongside free government vaccination in northern Nigeria.

Make visits easier

Incentives help offset transport and missed income while staff verify vaccination.

Support the existing system

The program also encourages demand and helps clinics address stock problems; these are one combined intervention, not separate health multipliers.

Scope of this review. An ordinary organizational gift is represented by a 90% marginal allocation to the vaccination core. This is a prior, not an audited share or second overhead deduction. All-in core costs already include administration. Other work, including ORS and delivery experiments, receives no numerical benefit credit.

2. Monitoring and information sharing

Clinic catchments in three northern Nigerian states

Cluster randomized evaluation, 2017–2020. Among 5,173 children aged 12–16 months across 167 clinic catchments, caregiver-reported BCG, Penta1 and measles coverage rose 16, 21 and 14 percentage points; full-series coverage rose 27 points.

Our assessment. Historical intervention evidence and context, not another numerical multiplier on the already adjusted mortality benchmark. Enrollment, additional vaccination and death-age denominators must remain distinct.

Historical Gambian pneumococcal-vaccine trial

Primary clinical plausibility evidence. Cutts et al. found a mortality benefit from PCV, supporting a causal pathway from vaccination to survival.

Our assessment. Historical intervention evidence and context, not another numerical multiplier on the already adjusted mortality benchmark. Enrollment, additional vaccination and death-age denominators must remain distinct.

Current New Incentives platform

Primary organizational reporting. The founder reports roughly $16 per enrolled child and acknowledges changing unit economics and new program experiments.

Our assessment. Historical intervention evidence and context, not another numerical multiplier on the already adjusted mortality benchmark. Enrollment, additional vaccination and death-age denominators must remain distinct.

3. Qualitative assessment

A randomized evaluation found higher vaccination coverage, and the core program is inexpensive relative to the consequences of preventable childhood disease.

Key reservations

  • GiveWell's August 2026 summary uses 2022–24 grant-weighted funding opportunities. Applying that historical yield to an ordinary gift is our assumption, not a guaranteed offer or a verified price for today's next dollar. The native estimate already accounts for other funders' responses. Our QALY figures are not GiveWell's moral weights or its own QALY estimates.
  • We assume 80% of modeled deaths avoided occur in early childhood and 20% at older ages. These are analyst priors, not measured portfolio shares. Early deaths receive a finite 40-year survival trajectory; older deaths receive 20 years. We adjust for background mortality and health quality, and discount future health at 3% annually. We do not add a further generic persistence discount centrally. None of these trajectories is a fitted national life table.
  • Every estimate charges the entire donation. A matched full-resource or net societal cost remains unknown: we cannot simply reuse the old per-net or per-child allowances after changing the model's denominator. Direct modeled SF and Bay Area health is zero; unknown indirect effects receive no credit. The global figure is not a local cost-effectiveness estimate.
  • We spread early avoided deaths equally across years 3–6 after donation. For later deaths, we use year 25, reflecting protection as the vaccinated cohort ages. These are explicit timing judgments. Unlike nets protecting current adults, infant vaccination can avert an adult death decades later, so the models should not use identical event dates.

Benefits not included in our estimate

  • No additional morbidity, income or education multiplier is added to this mortality calibration.
  • No direct SF/Bay health is credited; unknown indirect effects are not assumed impossible.

4. What do you get for your dollar?

$3,870 per 10 global QALYs

The original model estimated about $43,000 per 10 QALYs. Its joint cost, coverage and financing assumptions implied far fewer avoided deaths per dollar than the external benchmark. The revised estimate replaces that entire mortality calculation rather than adding GiveWell on top. We also distinguish enrolled infants from additional vaccinations: a coverage increase cannot be applied interchangeably to both denominators. We now anchor mortality to GiveWell's historical funding-opportunity estimates, then make our own explicit conversion from avoided deaths to quality-adjusted life years. The earlier models remain available as constructed stress tests. Their arithmetic was correct, but combining several uncalibrated discounts made their central estimates more pessimistic than the external mortality benchmark. We have not multiplied the new benchmark by those old discounts again.

A better life is our comparison unit of 10 additional quality-adjusted life years (QALYs), potentially spread across people. These are uncertain estimates, not measured returns or verified donation offers.

How we calculate the estimate

Gift-time incremental health: Gift × core share ÷ historical dollars per modeled death × relative mortality yield × age-weighted discounted future QALYs − new harms
$10,000 produces 25.842 modeled global QALYs; full gift ÷ QALYs × 10 = $3,870

Model inputs and assumptions
Historical cost per modeled life saved
$4,500 (range: Historical benchmark; relative-yield scenarios 0–2×). GiveWell's August 2026 summary uses 2022–24 grant-weighted funding opportunities. Applying that historical yield to an ordinary gift is our assumption, not a guaranteed offer or a verified price for today's next dollar. The native estimate already accounts for other funders' responses. Our QALY figures are not GiveWell's moral weights or its own QALY estimates. GiveWell 2022–24 opportunities, not next-gift quote.
Share of whole gift assigned to modeled core
0.9 (range: Central allocation; 100% sensitivity). The 90% core allocation is an analyst scope prior, not a sourced overhead rate or a second delivery-cost deduction. Existing grants already fund substantial work. We assume an ordinary gift has representative marginal health yield; we have not verified a particular unfunded offer at this price. Analyst prior, not overhead rate.
Early versus older death share
80% / 20% (range: 0–100% early). 80%early/20%older is an analyst prior for both. AMF Uganda example is supporting context, not a grant-weighted empirical share. NI share is not inferred from moral-weighted benefit percentages. Analyst prior.
Early-death survival trajectory
40 years; annual survival .99; utility .85 (range: Three-year tail sensitivity). All horizons, annual survival, utility and midpoint integration are analyst trajectories, not national lifetables. Finite truncation does not imply death at horizon. Not a fitted national life table.
Older-death survival trajectory
20 years; annual survival .98; utility .80 (range: Three-year tail sensitivity). All horizons, annual survival, utility and midpoint integration are analyst trajectories, not national lifetables. Finite truncation does not imply death at horizon. Not a fitted national life table.
Years from gift to prevented death
Early: 3, 4, 5, 6; older: 25 (range: Explicit conditional event schedule). We spread early avoided deaths equally across years 3–6 after donation. For later deaths, we use year 25, reflecting protection as the vaccinated cohort ages. These are explicit timing judgments. Unlike nets protecting current adults, infant vaccination can avert an adult death decades later, so the models should not use identical event dates. Analyst timing judgment.
Annual health discount rate
3% (range: Fixed in these scenarios). Discount gift-to-event and event-to-health intervals once each; midpoint annual integration. Model convention.
New shared and independent harms
0 QALYs (range: 0–0.1 present-value QALYs per specified gift). Only new harms not already in the source benchmark. Harm inputs are whole-gift present-value QALYs for the specified gift, not per dollar or per death; shared harm scales with relative yield, independent harm does not. Re-specify harms if changing gift scale. Sensitivity, not measured harm.

Representative ordinary gift

  • central: $3,870 per 10 global QALYs. 25.842 net QALYs for the whole $10,000 gift.
  • half-yield: $7,739 per 10 global QALYs. 12.921 net QALYs for the whole $10,000 gift.
  • double-yield: $1,935 per 10 global QALYs. 51.684 net QALYs for the whole $10,000 gift.
  • zero-yield: No positive-health ratio per 10 global QALYs. 0.000 net QALYs for the whole $10,000 gift.
  • all-early: $3,346 per 10 global QALYs. 29.883 net QALYs for the whole $10,000 gift.
  • all-older: $10,331 per 10 global QALYs. 9.679 net QALYs for the whole $10,000 gift.
  • short-tail: $26,348 per 10 global QALYs. 3.795 net QALYs for the whole $10,000 gift.
  • persistence-80: $4,837 per 10 global QALYs. 20.674 net QALYs for the whole $10,000 gift.
  • shared-harm: $3,885 per 10 global QALYs. 25.742 net QALYs for the whole $10,000 gift.
  • zero-yield-shared-harm: No positive-health ratio per 10 global QALYs. 0.000 net QALYs for the whole $10,000 gift.
  • zero-yield-independent-harm: No positive-health ratio per 10 global QALYs. -0.100 net QALYs for the whole $10,000 gift.
  • core-share-one: $3,483 per 10 global QALYs. 28.713 net QALYs for the whole $10,000 gift.

Uncertainty. The scenarios change assumptions; they are not confidence intervals. A donation can have no additional health effect, in which case there is no finite positive cost per QALY. Independently caused harm can make the health result negative even when benefits are zero. Harms already included in the source benchmark are not subtracted a second time. The roughly $100 difference between the two central figures is much smaller than the uncertainty in age mix, timing and marginal funding. It does not establish that one organization is better.

5. Funding and previous grants

Clarify current marginal allocation after existing grants and the remaining disease risk before alternative vaccination. These uncertainties do not make the conditional estimate a measured return.

GiveWell’s March 2025 extension funds existing support through March 2028. That funded baseline is not a newly available donation offer. The current model assumes representative historical mortality yield for an ordinary gift; current marginal funding room is unverified. Every estimate charges the entire donation. A matched full-resource or net societal cost remains unknown: we cannot simply reuse the old per-net or per-child allowances after changing the model's denominator. Direct modeled SF and Bay Area health is zero; unknown indirect effects receive no credit. The global figure is not a local cost-effectiveness estimate.

This review does not establish a verified marginal funding offer or a complete history of grants.

Donate

Opens the organization’s giving page. A general donation may not fund the specific activity modeled here; confirm allocation with the recipient.

6. Sources

  1. Donate. New Incentives. Primary organizational giving. Published: Undated current page; retrieved: September 8, 2026.
  2. Our Work. New Incentives. Primary program description. Published: Undated current page; retrieved: September 8, 2026.
  3. Impact of Conditional Cash Transfers on Routine Childhood Immunizations. IDinsight. Primary randomized evaluation brief; printed page 3. Published: November 2020; retrieved: September 8, 2026.
  4. Pneumococcal conjugate vaccine trial in The Gambia. Cutts et al.. Primary trial abstract. Published: 2005; retrieved: September 8, 2026.
  5. 2024 NDHS report launch. Nigeria Federal Ministry of Health. Primary national burden context. Published: 2025; retrieved: September 8, 2026.
  6. New Incentives founder AMA. Svetha Janumpalli. Primary operational account. Published: May 6, 2026, with later replies; retrieved: September 8, 2026.
  7. New Incentives extension of support in northern Nigeria. GiveWell. Primary funder record; not causal clinical evidence. Published: March 2025 grant; retrieved: September 8, 2026.
  8. Future Plans. New Incentives. Primary organizational planning. Published: Undated; mixed funding horizons; retrieved: September 8, 2026.
  9. Financials and Policies. New Incentives. Primary accounting-method description. Published: Undated; historical cost chart; retrieved: September 8, 2026.
  10. GiveWell: How We Produce Impact Estimates. GiveWell. Primary evaluator analysis; independent QALY conversion. Published: Mixed-vintage technical analysis; see linked source and model; retrieved: 8 September 2026.
  11. GiveWell: Mass Distribution of Insecticide-Treated Nets, especially section4.3. GiveWell. Primary evaluator analysis; independent QALY conversion. Published: Mixed-vintage technical analysis; see linked source and model; retrieved: 8 September 2026.
  12. GiveWell: New Incentives technical analysis. GiveWell. Primary evaluator analysis; independent QALY conversion. Published: Mixed-vintage technical analysis; see linked source and model; retrieved: 8 September 2026.
  13. GiveWell: NI extension of support in Northern Nigeria. GiveWell. Primary evaluator analysis; independent QALY conversion. Published: Mixed-vintage technical analysis; see linked source and model; retrieved: 8 September 2026.

Annual expenses: years and sources

Average annual expenses (three consecutive fiscal years): Not available. Organization size is separate from the modeled cost-effectiveness of a donation.

New Incentives

Three years of organization-level expenses have not yet been verified for this report. No other organization or fiscal sponsor budget has been substituted.

Why does this differ from GiveWell?

GiveWell’s August 2026 summary estimates $4,500 per life saved for this program, based on its 2022–2024 funding opportunities. This is a modeled mortality outcome—not a QALY estimate or a quote for the next unrestricted gift.

Our original v1 scenario implied $51,440 per early death prevented, before converting survival into QALYs. It credited about 13.65 discounted QALYs per prevented death, using a finite 40-year survival curve, background mortality, .85 utility, .8 persistence and 3% discounting. Those survival inputs are judgments, not measured life tables.

Using GiveWell’s mortality estimate with that same event-time survival assumption gives $3,298 per 10 QALYs, before a new gift’s implementation delay. Using an illustrative 50 QALYs per life instead gives $90 per QALY, or $900 per 10 QALYs. Fifty undiscounted years are not automatically fifty discounted QALYs.

GiveWell’s aggregate lives-saved estimate may include different ages and timing from our early-child-death model. Applying the same QALYs per life here is a diagnostic assumption, not an age-matched survival calculation.

What we learned

There is no factor-of-ten arithmetic error. Our original model compounds conservative transfer and funding assumptions that were not calibrated to GiveWell’s analysis. Its result should be read as a constructed scenario, not proof that GiveWell overstates impact. We should not apply our full adjustment ladder again to GiveWell’s already-adjusted mortality estimate.

New Incentives has an especially important denominator difference: our cost is per eligible catchment infant, while GiveWell’s technical example uses enrolled infants. Coverage gains cannot be multiplied across those denominators without an enrollment conversion. A separate 70% funding penalty also accounts for much of our lower modeled impact. These differences require matched state and funding assumptions, not an automatic replacement with a national average.

GiveWell evaluates specific funding opportunities. Displacing its funding may move impact to another program rather than eliminate it. Conversely, a historical average does not establish the effect of every direct gift. The current v2 report replaces that mortality ladder with the historical benchmark and age-aware timing assumptions. We retain the original model for auditability. None of these global calculations establishes SF benefit.

Inspect the comparison inputs and formulas.

How much might this help San Francisco?

Direct benefits accrue overseas. Preventing infections could indirectly protect SF residents through travel and reduced importation, but no evidence currently calibrates this charity’s local effect. We leave the SF comparison price unquantified rather than show its global price as a local bargain.

Tiny local-spillover math

If additional SF health were one millionth of the modeled direct overseas health, the same gift would cost $3.9B per 10 SF QALYs. This is an illustrative coefficient, not an estimated share or an evidence-based bound.

These scenarios carry forward the direct model’s finite schedule only as a simplifying diagnostic. They do not model an infinite transmission or innovation tail. Overseas health is not reassigned to SF; SF is nested within Bay, so the two cannot be added.

Relevant mechanisms: measles importation and rare local malaria transmission. Neither source estimates AMF or New Incentives’ effect on SF.