Leverage Factor (average 2007-2014)
Year ACTION US budget Key US achievement Real world outcome Economic value in Western terms ACTION's role ACTION's value add
2014 $820k Unknown - - - $0
2013 $820k Global Fund for AIDS, TB and Malaria - US pledge of $5b over 3 years ($1.0b increase) pending - - $0
2012 $850k Vaccine and Global Fund Appropriations made Vaccine and Global Fund pledges real recorded in pledges - $0
2011 $750k Vaccines - US pledge of $450m over 3 years to GAVI Alliance (~$150m increase) 124k children's lives saved $310b 80% $250b
2010 $660k Global Fund for AIDS, TB and Malaria - US pledge of $4b over 3 years ($1.1b increase) 14-51m DALYs saved $1260b-4590b 30% $380b-1380b
2009 $560k US TB Appropriations +$50m 15.2m DALYs saved $1370b 75-80% $1030b-1090b
2008 $570k Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act ($4b TB authorization over 5 years) enables future TB appropriations $0 - $0
2007 $740k US TB Appropriations Bilateral TB and Global TB Drug Facility +$70m 27.3m DALYs; adjust 2009 4.7 years to 5.6 years $2460b 75% $1840b
Totals $5.8m $3500b-4560b

Leverage Factor

600,000 - 800,000

(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 2,000-20,000 range, and our lobbying and advocacy page suggests lobbying and advocacy may magnify the underlying leverage factor 20-40 fold.

Notes:

2014. RESULTS have not yet published their 2014 achievements.

2013. ACTION helped secure a US pledge of $5b over 3 years to the Global Fund for AIDS, TB and Malaria (a $1b increase over the previous 3 year pledge). A FY2014 contribution of $1.65b was in keeping with this pledge, however the FY2015 proposed budget contains only a $1.35b contribution. We are waiting to see how FY2016 shapes out before counting this as a win for ACTION.

2011. We conservatively don't count funding as having occurred until the funds are delivered to GAVI; 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 post pledge for 2012-2012 has been $130m, $138m, $175m; 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) / $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 have been pledged by the US and are being appropriated; FY2011 appropriation was $1.05b, an increase of $0 over FY2010; FY2012 appropriation was $1.3b, but $250m of this was a transfer from the State Department's bilateral HIV/AIDS budget, so only the increased cost effectiveness of TB and malaria should be counted as a win; FY2013 appropriation was $1.65b, but after a 0.1% rescission and a 5% sequestration, this amounted to $1.57b, an increase of $520m over FY2010 (it is debatable whether a $173m pre-sequestration reduction in bilateral HIV/AIDS should be counted as a loss; to be conservative we consider it a loss); 55% funding goes to HIV (Global Fund through 2010 had disbursed $7.7b of $14.1b for HIV); $493/yr patient on ART (Towards an improved investment approach to an effective response to HIV/AIDS, The Lancet 2011, webappendix); not all funds may go on ART, but assuming this is the least effective intervention, this provides a lower bound on effectiveness; 29% funding goes to Malaria (Global Fund through 2010 had disbursed $4.1b of $14.1b for Malaria); assume $5-31/DALY based on Nothing but Nets page; 16% funding goes to TB (Global Fund through 2010 had disbursed $2.3b of $14.1b for TB); assume $240 to treat based on tuberculosis treatment page and 13 DALYs saved per treatment per note on TB treatment; ($250m + $520m) * (54% / $493 + 29% / $5-31 + 16% / $240 x 13) - ($250m + $173m) / $493 = 14m-51m DALYs saved.

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 6 years), discounted at say 3%, or 5.6 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 $240 to treat based on tuberculosis treatment page and 13 DALYs saved per treatment per note on TB treatment; $50m / $240 x 13 x 5.6 = 15.2m DALYs saved.

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 8 years), discounted at 3%, or 7.2 years; assume $240 to treat based on tuberculosis treatment page and 13 DALYs saved per treatment per note on TB treatment; $70m / $240 x 13 x 7.2 = 27.3m DALYs saved.

Note on TB treatment. In Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review it is reported: "Untreated smear-positive tuberculosis among HIV negative individuals has a 10-year case fatality variously reported between 53% and 86%, with a weighted mean of 70%.". The Disease Control Priorities Project (DCP2) (pg. 294) reports 82% of treated TB cases treated are cured. So 70% * 82% = 57% are the odds of saving a life as a result of TB treatment. The DCP2 (pg. 418) gives 35.9m DALYs(time discounted at 3%, no age weighting) a year as the burden of TB in 2001, and in that same year (pg. 415) 1.6m deaths due to TB, so 35.9m / 1.6m = 22.4 is the number of DALYs per death for TB. Combining these a TB treatment saves 57% x 22.4 = 13 DALYs. Because of the definition of DALYs this figure incorporates both the death and disability components of TB infection. It also includes both regular and MDR-TB cases.

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 ACTION's role. ACTION's role estimates made in conjunction with ACTION.