Our Big Bet for the Future 2015 Gates Annual Letter (2)

The Breakthroughs

Health: Child deaths will go down by half, and more diseases will be eradicated than ever before

Until recently, the world was split in two.

In one half, virtually all children were vaccinated, had sufficient nutrition, and received proper treatment for common illnesses like diarrhea and pneumonia. The number of children in this half who died before they reached the age of 5 was well under 1 percent.

Then there was the other half.

Here, vaccination coverage was spotty at best, children tended to be malnourished, and standard childhood illnesses went untreated. About 15 percent of these children died before they turned 5; in some countries that percentage was much higher.

When we started our foundation, we were looking for the most strategic ways to help equalize the two halves of the world. We thought that if the world put a little more innovation behind saving the lives of poor children—for example, close to the same amount of innovation that goes into making computers faster and smaller—we could make a lot of progress.

When we look at the progress the world has made in the past generation, since 1990, we believe global health equity is an achievable goal. Increased investment in health care has led to better coverage with the vaccines and treatments that were already available, and intensified R&D has led to the development of new vaccines and treatments. The percentage of children who die before age 5 has been cut in half.

We predict that the next 15 years will see the pace of these developments increase even faster. The world is going to make unprecedented progress in global health.

Here are some achievements that are within the grasp of the “other” half of the world.

Cutting the number of children who die before age 5 in half again.

In 1990, one in 10 children in the world died before age 5. Today, it’s one in 20. By 2030, that number will be one in 40. Almost all countries will include vaccines for diarrhea and pneumonia, two of the biggest killers of children, in their immunization programs. Better sanitation—through simple actions like handwashing as well as innovations like new toilets designed especially for poor places—will cut the spread of disease dramatically. And we’re learning how to help more mothers adopt practices like proper breastfeeding and skin-to-skin contact with their babies that prevent newborns from dying in the first month after they’re born. (Newborn deaths have gone down at a slower rate than deaths of older children and now account for almost half of all child deaths.) Many poor countries have built strong health care systems in the past 25 years, and in the next 15 years other countries will pick up on their ideas and provide more care—and higher quality care—for newborns and young children. Ultimately, this will mean millions of people alive and thriving who would have died.

Reducing the number of women who die in childbirth by two thirds.

In countries around the world, more and more mothers are giving birth in health care facilities instead of at home. Since 2005, for example, the proportion of mothers delivering at facilities in Rwanda has gone from 31 percent to 72 percent. In Cambodia, it has shot up from 20 percent to 57 percent. By continuing to make sure that the caregivers at those facilities are well-supplied and well-trained, we can take advantage of this global trend and make childbirth much safer for women around the world. In addition, maternal mortality will drop as more women get access to contraceptives and information about spacing their pregnancies safely. As that number goes up, the number of mothers dying will go down.

Wiping polio and three other diseases off the face of the earth.

Destroying a disease utterly is a very difficult thing to do—so difficult, in fact, that it’s happened only once in history, when smallpox was eradicated in 1980. But if we keep working hard, we can eradicate four diseases by 2030. We can get polio out of Africa this year and out of every country in the world in the next several years. Guinea worm, an incredibly painful disease whose sufferers spend months incapacitated while worms that can be several feet long burst out of their legs, will also be gone soon, thanks in large part to the leadership of President Jimmy Carter and the Carter Center. We’ll also see the last of diseases like elephantiasis, river blindness, and blinding trachoma, which disable tens of millions of people in poor countries. The drugs that can stop these scourges are now being donated in huge numbers by pharmaceutical companies, and they’re being used more strategically thanks to advances in digital maps that show where diseases are most prevalent. Last year these free medicines were distributed to 800 million people.

Finding the secret to the destruction of malaria.

We won’t be able to completely eradicate malaria by 2030, but we will have all the tools we need to do so. These will include a vaccine that prevents people with malaria from spreading it to the mosquitoes that bite them, a single-dose cure that clears the parasite completely out of people’s bodies, and a

diagnostic test that can reveal right away whether a person is infected. Early versions of all these tools are in development now. In 15 years, we’ll be poised to send malaria the way of smallpox and polio.

Forcing HIV to a tipping point.

As we make progress toward a vaccine or a cure, the number of people beginning treatment in sub-Saharan Africa will finally outstrip the number of people newly infected. When we reach that point in the region with the most dense HIV transmission in the world, cases will start going down everywhere around the globe for the first time since the disease was discovered more than 30 years ago.

This (partial) list of breakthroughs gives a phenomenal picture of how much progress can be made in just 15 years. Life will get better, faster, because the number of innovations reaching the poor will be greater than ever before.