Throughout my careers in software and
philanthropy—and in each of my annual letters—a recurring theme has been
that innovation is the key to improving the world. When innovators work
on urgent problems and deliver solutions to people in need, the results
can be magical.
Right now, just over 1 billion people—about 15 percent of the people
in the world—live in extreme poverty. On most days, they worry about
whether their family will have enough food to eat. There is irony in
this, since most of them live and work on farms. The problem is that
their farms, which tend to be just a couple acres in size, don’t produce
enough food for a family to live on.
Fifteen percent of the world in extreme poverty actually represents a
big improvement. Fifty years ago, about 40 percent of the global
population was poor. Then, in the 1960s and 1970s, in what is called the
“Green Revolution,” Norman Borlaug and other researchers created new
seed varieties for rice, wheat, and maize (corn) that helped many
farmers vastly improve their yields. In some places, like East Asia,
food intake went up by as much as 50 percent. Globally, the price of
wheat dropped by two-thirds. These changes saved countless lives and
helped nations develop.
We have the ability to accelerate this historic progress. We can be
more innovative about delivering solutions that already exist to the
farmers who need them. Knowledge about managing soil and tools like drip
irrigation can help poor farmers grow more food today. We can also
discover new approaches and create new tools to fundamentally transform
farmers’ lives. But we won’t advance if we don’t continue to fund
agricultural innovation, and I am very worried about where those funds
will come from in the current economic and political climate.
"My annual letter this year is an
argument for making the choice
to keep on helping extremely
poor people build self-sufficiency."
- bill gates
The world faces a clear choice. If we invest relatively modest
amounts, many more poor farmers will be able to feed their families. If
we don’t, one in seven people will continue living needlessly on the
edge of starvation. My annual letter this year is an argument for making
the choice to keep on helping extremely poor people build
self-sufficiency.
My concern is not only about farming; it applies to all the areas of
global development and global health in which we work. Using the latest
tools—seeds, vaccines, AIDS drugs, and contraceptives, for example—we
have made impressive progress. However, if we don’t make these success
stories widely known, we won’t generate the funding commitments needed
to maintain progress and save lives. At stake are the future prospects
of one billion human beings.
Innovation in Agriculture
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innovation in agriculture
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The private market does a great job of
innovating in many areas, particularly for people who have money. The
focus of Melinda’s and my foundation is to encourage innovation in the
areas where there is less profit opportunity but where the impact for
those in need is very high. That is why we have devoted almost $2
billion to helping poor farm families, most of which are led by women,
boost their productivity while preserving the land for future
generations. Those funds are invested in many areas of innovation,
ranging from sustainable land management, to better ways to educate
farmers, to connecting farmers to functioning markets.
We do all these things with one goal in mind—helping people like
Christina Mwinjipe, a farmer I met last year in Tanzania. Christina
supports her family by farming cassava, a staple crop that provides a
basic diet for more than 500 million people worldwide. (When dried to a
powder, cassava is known as tapioca.) In the past two years, Christina’s
crop has been invaded by two cassava diseases. The leaves of some of
her plants are curled and withered, and covered in the white flies that
carry mosaic disease. The roots of other plants are rotted by brown
streak disease. Because of these diseases, she is depleting her savings
to buy cassava to feed her three children. Her oldest son just passed
his examinations to enter secondary school, but she doesn’t know where
she’ll find the money to pay his fees. She is not sure what she will do
about food when her savings run out.
Christina Mwinjipe inspects her cassava crop
(Mapinga Village, Tanzania, 2012).
Farming is a great example of something critical to the poor that
gets very little attention in rich countries. Back in the 19th century,
the majority of people in the United States worked in agriculture. Now
less than 2 percent of the workforce is involved in farming, and less
than 15 percent of U.S. consumer spending goes to food. Farming issues
rarely make the news. The exceptions are when food is contaminated, when
government subsidies are being debated, or when there is a famine like
the current one in the Horn of Africa.
For Christina and other small farmers—and for hundreds of millions
of extremely poor people living in slums in big cities—getting food is
the most pressing daily concern. And food is strongly connected to
another constant worry: basic health. The lack of adequate nutrition is a
key reason why poor children so often die of diseases like diarrhea
that richer and better-fed children are able to fight off. Poor
nutrition in childhood also prevents the development of both the brain
and the body, severely and irreversibly limiting children’s ability to
grow, learn, and become healthy, productive adults. Ultimately, there is
very little in Christina’s life—or her children’s lives—that doesn’t
depend on her cassava crop.
Despite the rich world’s distance from farming, food-related issues
are important for all of us. In the 1960s and 1970s, when I was in high
school, people worried that we simply couldn’t grow enough food to feed
everyone in the world. A popular book that came out in 1968, The
Population Bomb by Paul Ehrlich, began with the statement: “The battle
to feed all of humanity is over. In the 1970s hundreds of millions of
people will starve to death in spite of any crash programs embarked upon
now. At this late date nothing can prevent a substantial increase in
the world death rate…” Fortunately, due in large part to the Green
Revolution, this dire prediction was wrong.
But the world’s success in warding off famine led to complacency.
Over time, governments in both developed and developing countries
focused less on agriculture. Agricultural aid fell from 17 percent of
all aid from rich countries in 1987 to just 4 percent in 2006. In the
past 10 years, the demand for food has gone up because of population
growth and economic development—as people get richer, they tend to eat
more meat, which indirectly raises demand for grain. Supply growth has
not kept up, leading to higher prices. Meanwhile, the threat of climate
change is becoming clearer. Preliminary studies show that the rise in
global temperature alone could reduce the productivity of the main crops
by over 25 percent. Climate change will also increase the number of
droughts and floods that can wipe out an entire season of crops. More
and more people are raising familiar alarms about whether the world will
be able to support itself in the future, as the population heads toward
a projected 9.3 billion by 2050.
I believe these new dire predictions can be wrong, too. We can help
poor farmers sustainably increase their productivity so they can feed
themselves and their families. By doing so, they will contribute to
global food security. But that will happen only if we prioritize
agricultural innovation.
Agricultural Research
Given the central role that food plays in human welfare and national
stability, it is shocking—not to mention short-sighted and potentially
dangerous—how little money is spent on agricultural research. In total,
only $3 billion per year is spent on researching the seven most
important crops. This includes $1.5 billion spent by countries, $1.2
billion by private companies, and $300 million by an agency called the
Consultative Group on International Agricultural Research (CGIAR). Even
though the CGIAR money is only 10 percent of the spending, it is
critical because it focuses on the needs of poor countries. Very little
of the country and private spending goes toward the priorities of small
farmers in Africa or South Asia.
"We can help poor farmers
sustainably increase their
productivity so they can feed
themselves and their families.
But that will only happen if we
prioritize agricultural innovation."
- bill gates
This shortage of funds for research is particularly worrying because
of the increasing prevalence of plant diseases, such as those
destroying Christina Mwinjipe’s cassava plants. Just like humans, plants
get attacked by viruses, bacteria, and fungi. They also have to defend
themselves against insects or animals, but unlike humans they can’t run
away from their predators. Plants have developed sophisticated systems
for defending themselves that we are just starting to understand. One
amazing discovery is that in some species when one plant is attacked it
gives off a scent that tells other plants to focus their energy on
defending themselves rather than on growing.
Because farmers plant seeds that give them the highest yields, the
diversity of crop varieties in fields is quite limited. This creates a
perfect opportunity for disease to spread. A famous example of this is
the potato blight that spread across Europe in the 1840s and led to mass
starvation in Ireland. Less well known is the southern corn leaf blight
that swept through the United States in the early 1970s. Fortunately,
in that case, the United States had sufficient strategic reserves to
avert a crisis.
Norman Borlaug, Nobel Prize winner and father of the Green
Revolution, first got involved in plant science after he heard a
professor give a speech entitled “These Shifty Little Enemies That
Destroy Our Food Crops.” The Rockefeller Foundation enticed Borlaug to
move to Mexico, where he created new varieties of wheat that were
resistant to a fungus called wheat stem rust. It was only after he got
there that he figured out additional strategies to increase wheat
productivity. Borlaug was always concerned that new forms of wheat rust
would emerge. Unfortunately, he was proven right in 1999 when a new and
extremely virulent wheat rust called Ug99 was found in Uganda. Though
Ug99 is still mostly in Africa, it has jumped the Red Sea and is now
being found in Iran and Yemen, on its way toward India.
Stalks of wheat at a Ug99 wheat stem rust nursery. ©Cornell University
The response to Ug99 started slowly, but great work by a collection
of experts, including researchers in Ethiopia and Kenya, has led to new
varieties with some level of resistance. A huge effort is being
undertaken to make sure that the new resistant varieties are adopted
broadly before the disease moves into Asia or the Americas.
Another area where scientists need to do a lot more study is the
effects of climate change on agricultural productivity. It looks like
there may be varieties of rice and other crops that can deal with the
higher temperatures and weather variations better than today’s plants.
Some plant varieties actually benefit from the increased CO2 levels,
although there is no clear data on how significant this will be. Early
greenhouse studies were very promising, but field studies have shown
much smaller effects. The world must invest in a variety of techniques
to help poor farmers deal with weather impacts better than they can
today.
Dr. Abdel Ismail inspects rice varieties being tested for flood tolerance
(Laguna, Philippines, 2008).
©IRRI, Ariel Javellana
For example, when I was in India in March I met with about 20 rice
farmers who had recently switched to a new rice seed called Swarna-Sub1,
which is both very productive and can survive in flooded fields. Their
rice fields get flooded every three to four years, and in past flood
years they ended up with almost no food to eat. Now, these farmers can
feed their families no matter the weather. Currently, 4 million tons of
rice are lost to flooding every year in Bangladesh and India. But as
farmers in the region adopt Swarna-Sub1, they will grow enough extra
rice to feed 30 million people.
Fortunately, there are reasons to believe that the chronic
underfunding of research in agriculture is starting to change—and that
there will be more breakthroughs like Swarna-Sub1. One approach that
looks promising is innovative partnerships with private companies where
the companies donate proprietary assets in which they have invested
hundreds of millions of dollars, as well as their expertise, to help
make appropriate varieties available royalty-free to poor farmers. Other
key partners are rapidly growing countries like Brazil and China, which
bring not only new resources but also deep experience in helping poor
farmers at home. Brazil is a leader in soybeans, cassava, and tropical
soils. China is a leader in rice and farmer education. This year the
foundation entered into model agreements to work with both countries.
There is also an extremely important revolution—based on
understanding plant genes—taking place in the plant sciences. The tools
that enable this revolution were created to help cure human diseases.
The field of agriculture is just now in the process of figuring out how
to take advantage of these tools, but it’s clear that they will greatly
accelerate the pace of plant research. It is hard to overstate how
valuable it is to have all the incredible tools that are used for human
disease to study plants.
Historically, increasing the productivity of a crop meant finding
two seed variants, each with some desirable and undesirable
characteristics, and crossing them until you get a combination with
mostly the good characteristics of the two parents. This required
actually growing tens of thousands of plants to see how they develop in
different growing conditions over time—for example, when water is
plentiful and when it is not.
Now the process is quite different. Imagine the analogy of a large
public library with rooms full of books. We used to have to use the card
catalogue and browse through the books to find the information we
needed. Now we know the precise page that contains the piece of
information we need. In the same way, we can find out precisely which
plant contains what gene conferring a specific characteristic. This will
make plant breeding happen at a much faster clip. The private sector
has moved the fastest to use new approaches, but academic groups,
including a Chinese group called BGI that has more sequencing capability
than any other group in the world, are catching up.
When I was in Tanzania meeting Christina Mwinjipe, I also met Dr.
Joseph Ndunguru, a plant scientist leading a project to fight the mosaic
and brown streak diseases that are attacking Christina’s cassava crop.
Dr. Ndunguru is part of a new generation of African scientists building
up the capacity to do innovative science in Africa. Dr. Ndunguru was
offered a high-paying job in South Africa, but he chose to keep working
for the Tanzanian national program. I asked him why, and he replied that
the work he was doing with the national program was the best way he
could connect state-of-the-art science with the needs of the local
farmers.
Dr. Joseph Ndunguru researches crop samples in his lab
(Dar es Salaam, Tanzania, 2012).
When I talk about innovation, it can be abstract for some people.
But the direct link between the challenges Christina faces when her crop
is destroyed and the solutions that Dr. Ndunguru is working on every
day makes it very concrete. Disease-resistant cassava is an answer to
Christina’s prayers, and I look forward to the day when Dr. Ndunguru’s
work is done and I can go back to Tanzania and see Christina’s field
thick with healthy cassava plants. That is why I say that innovation has
been and will continue to be the key to improving the world.
Global Health
Most of the foundation’s resources go
to global health issues, and our guiding principles for those
investments are the same as for agriculture: Innovation is the means,
and equity is the end goal. When Melinda and I started this work more
than a decade ago, we were inspired by the conviction that “all lives
have equal value.” So one of the first things we invested in was
vaccines, which protect all children who receive them, no matter how
rich or poor they may be. In short, vaccines work. Two years ago,
Melinda and I called on the global health community to make this decade
the “Decade of Vaccines.”
The organization responsible for helping poor countries introduce
new lifesaving vaccines is called the GAVI Alliance. Last summer, GAVI
hosted a meeting to get pledges from donor countries and organizations.
The goal was to raise at least $3.7 billion over five years, and we knew
it wasn’t the ideal time to be asking for that kind of money.
Throughout the spring, we really didn’t know if we were going to make
it. Finally, a few weeks before the conference began, the pledges
started trickling in—and they were consistently at the top of the range
we’d expected. On the last day, we were tallying up the numbers as they
came in to see what the total would be. GAVI ended up receiving $4.3
billion in pledges.
Children wait to be vaccinated with a brand new vaccine that protects against meningitis A
(Ouagadougou, Burkina Faso, 2010).
©PATH, Gabriel Bienczycki
Because of that money, the poorest infants in the world will start
receiving the same vaccines that infants in rich countries receive. Due
to donors’ generosity and to significant price reductions from vaccine
manufacturers, GAVI is now supporting two relatively new vaccines,
rotavirus (to prevent the leading cause of diarrhea) and pneumococcus.
By 2015, these vaccines will prevent 190,000 diarrheal deaths and
480,000 respiratory deaths—not to mention improving the overall health
of hundreds of millions of children. The money that has been pledged to
GAVI will save 4 million lives by 2015.
That’s why I think of June 13, 2011, the date of the pledging
conference, as a historic day for global health equity. It was an
emotional moment for Melinda and me. We were happy that our foundation
played a role in helping the world reach that milestone. But what really
moved us was the fact that so many partners share our vision of an
equitable world and are willing to put money behind it, even in these
tough times. When people know the kind of impact their generosity has,
they are not only willing but eager to help.
There were other huge milestones in global health last year. There
were also a few setbacks. In this section of my letter, I will talk
about those milestones and setbacks, the challenges that lie ahead, and
the solutions that excite me most.
Vaccines
"Because of that money, the
poorest infants in the world
will start receiving the same
vaccines that infants in rich
countries receive."
- bill gates
There are still years of work to be done to introduce the diarrhea
and pneumonia vaccines into every country. Moreover, global coverage of
basic childhood vaccines is around 80 percent, which is good compared to
many other health interventions but leaves one out of five children
unprotected. We need to recreate the high-level political focus that
this issue received during the 1970s, when dedicated effort brought us
from just 20 percent coverage to 80 percent coverage in most countries
in just a decade.
When I spoke at the World Health Assembly last May, I announced that
I was creating the Gates Vaccine Innovation Award. We were pleased to
receive 117 nominations encompassing a lot of amazing work. Vaccines are
the only high-technology product that needs to be delivered to every
single child. To miss zero children, it takes an incredible amount of
ingenuity, and that’s why we created the award.
Melinda meets with Dr. Asm Amjad Hossain, the recipient of the first Gates Vaccine Innovation Award
(Dhaka, Bangladesh, 2012).
I am pleased to announce here that the first award will recognize
the work of Dr. Asm Amjad Hossain, a district immunization medical
officer from Bangladesh. In 2009, Dr. Hossain was assigned to two
districts where immunization rates were 67 and 60 percent, respectively.
In 2010, they were 85 and 79 percent. These rapid improvements were the
result of Dr. Hossain’s innovative approach to running an immunization
program. He instituted a process of registering pregnant women with
their expected date of delivery, location, and phone number, so
vaccinators knew when children were born, where they were, and an easy
way to contact their mothers. He provided annual schedules for vaccine
sessions to make vaccinators more accountable to the community and had
the vaccinators put their phone numbers on the children’s immunization
cards, so parents with young children could get in touch with a health
worker. These may seem like small innovations, but they show how looking
at old problems in new ways can make a profound difference.
Improvements like these are spreading to other locations because of the
commitment and creativity of Dr. Hossain and many others like him.
Delivering lifesaving vaccines takes the dedication of many well-known
players like GAVI, the World Health Organization, and UNICEF; government
officials; and perhaps most importantly hundreds of thousands of heroes
on the frontline like Dr. Hossain.
Polio
The foundation’s top priority remains helping to complete the
eradication of polio, perhaps the best-known vaccine-preventable disease
in the world. I spend a lot of my time learning about the disease and
being an advocate for doing what it takes to end polio. At the start of
2011, poliovirus was still spreading in three areas: 10 countries in
Africa (with viruses that originated primarily in Nigeria), Afghanistan
and Pakistan, and India.
Polio vaccinators crossing the Ganges River on the last day of the polio campaign
(Bihar, India, 2010).
Now India has reached a huge milestone. The country had only one
case in 2011, which was recorded on January 13 in West Bengal. So on
January 13, 2012, India celebrated its first year of being polio free.
The challenge in India was mind-boggling. It’s hard to imagine how you
would design a polio campaign that reached every Indian child. More than
a billion people live in the country. Massive numbers of families
migrate constantly to find work. One of the largest states, Bihar, is
flood-prone. In some cases, the vaccine didn’t work as well as it had in
other parts of the world, probably because of malnourishment, diarrhea,
and other illnesses. But the government kept raising awareness and
improving the quality of its campaigns, even in the toughest locations.
The Indian government deserves special credit for this achievement.
Girl receives polio drop in the Fulani settlement in Mashakeri Village
(Kebbi, Nigeria, 2011).
In 2012 we need to keep India and all the other places that are
polio free from getting re-infected. The biggest focus for 2012 will be
improving the polio vaccination campaigns in Nigeria, Chad, the
Democratic Republic of Congo, Afghanistan, and Pakistan. I recently
visited Chad and Nigeria to meet with leaders there, and it’s clear that
we have high-level political support. Still, deploying high-quality
vaccination teams and educating parents so that every single child is
vaccinated will take a lot of work. In Nigeria our biggest problems are
low-quality campaigns and the fact that some parents don’t trust that
the vaccine is safe. In Pakistan these problems are compounded by the
security situation.
It will be challenging to continue raising the approximately $1
billion per year it takes to run the global campaign. Last year the
United States, the United Kingdom, Australia, Japan, Canada, Norway,
Saudi Arabia, the Crown Prince of Abu Dhabi, and Rotary International
provided substantial contributions. Rotary continues to be the heart and
soul of polio eradication, supporting the program directly while also
taking on a larger role in encouraging other donors to give more. A new
partner, FC Barcelona, is spreading the message of polio eradication to
millions of football fans across the globe.
We are continuing to invest in studies about how polio spreads and
trying to model where we need to intensify the vaccination campaigns. We
are also working on new vaccines. Finding every last poliovirus
requires good tools along with trained and motivated workers in every
single country.
These are enormous obstacles, but the success of the polio
eradication program in India and 90 other countries gives me confidence
that we can triumph in these final challenging countries and end polio
once and for all.
AIDS and the Global Fund
The AIDS community has three big goals:
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Reduce the number of people getting infected. By 2015, the goal is
to cut infections to 1 million per year, which would represent a 68
percent drop from the peak a decade ago.
-
Provide drugs for everyone who needs them, so those with AIDS can
live longer and more productive lives. Last year, 1.8 million people
died of AIDS.
-
Find a cure. Although there are people working toward a cure, it is
viewed as so difficult that we can’t count on ever having one.
Nineteen-year-old Bayeza Manzini speaks to soccer players about the benefits of circumcision
(Matsapha, Swaziland, 2010).
There are many ways to tackle the first goal: reducing infection.
These methods can work individually and in combination. One approach is
to convince people to avoid risky behavior. Education efforts are
important, and they are getting more targeted, but their impact is
uncertain.
A second approach is male circumcision, which reduces HIV
transmission by up to 70 percent. Funding for circumcision is finally
being prioritized, since the cost is quite low and the protection is
lifelong. Over 1 million men ages 15–49 have been circumcised in 14
Southern and Eastern African countries with large AIDS epidemics, but
that is only 5 percent of the total number who could benefit from the
procedure. Even in the ancient practice of circumcision, innovation has
the potential to make a big difference. The new PrePex and Shang Ring
devices simplify the procedure and make surgery unnecessary. The first
studies suggest that these devices are both safe and effective. (I will
keep this letter G-rated by leaving out the pictures of how the devices
work.) Botswana, Kenya, South Africa, and Tanzania are starting to show
leadership by getting the message out to all young men that it is
important to get circumcised. Kenya has made the most progress,
circumcising 70 percent of eligible men. I will be very disappointed if,
by 2015, any fewer than 15 million young men have chosen to protect
themselves and their partners by getting circumcised.
A third approach to prevention is to come up with an injection or
pill or gel that reduces an uninfected person’s chance of becoming
infected. The final results of studies of a number of these tools were
reported in the last 18 months. In studies where the patients used the
tool as they were supposed to, the results were quite good. However, in
most studies the levels of usage were low and thus the overall results
were disappointing. This has the field thinking hard about how you could
motivate better adherence or create a tool that requires less effort
from the patient. One example in early development is an injection that
lasts 30 to 90 days. I think we will solve the adherence problem, but we
are going to have to get medical scientists, social scientists,
community representatives, and regulators working together. We have to
develop and test overall delivery systems, including communication,
support, and incentives, in ways that go beyond what a medical trial
alone typically does.
A fourth approach, called treatment for prevention, is to give
antiretroviral (ARV) drugs to people with AIDS earlier in the course of
their disease, greatly reducing the chance that they will infect others.
This is already done for pregnant mothers to reduce the chance of
infecting their babies during delivery or through breast-feeding. The
field has a goal of getting drugs to 90 percent of HIV-positive mothers
by 2015, virtually ending mother-to-child transmission. The main problem
with treatment for prevention is that most people who are infected with
and transmitting HIV don’t know they are infected, so you wouldn’t know
to give them drugs. In order to realize the full potential of treatment
for prevention, we need to encourage widespread HIV testing, which will
require developing a reliable, inexpensive saliva test that can be used
privately.
"More than 6.6 million people
are alive today because they
are taking ARV drugs. Ten years
ago it looked as if almost all of
these people would die because
the drugs were only available
in rich countries."
- bill gates
One further approach to prevention is an AIDS vaccine. On this
topic, this year’s news is very similar to last year’s. The scientific
understanding of the AIDS virus—its shape, how it enters cells, and how
we can use antibodies to block it—has advanced more than expected.
However, plans for conducting trials of different constructs are still
not as aggressive as they should be, given how game-changing a vaccine
would be. It is still possible to have a vaccine within 12 years, but it
will take some luck and better planning.
It is exciting to have so many prevention approaches available, and
to be making progress on most of them. Funding continues to be a serious
concern, but I am optimistic that the field will develop combined
approaches to significantly bring down the rate of infection.
Meanwhile, there has also been amazing progress on the second major
goal for the AIDS community: scaling up treatment. This is due mostly to
the Global Fund to Fight AIDS, Tuberculosis and Malaria, and to a U.S.
program called PEPFAR: the United States President’s Emergency Plan for
AIDS Relief. More than 6.6 million people are alive today because they
are taking ARV drugs. Ten years ago it looked as if almost all of these
people would die because the drugs were available only in rich
countries.
Between 2008 and 2010 the Global Fund gave $8 billion for AIDS (57
percent), malaria (29 percent), and tuberculosis (14 percent). Other
than PEPFAR for AIDS, the Global Fund is the biggest donor for all three
of these diseases. It provided the money for 230 million bednets, which
have been key to the 20 percent decline in malaria deaths over the past
decade. It also provided treatment for 8.6 million cases of
tuberculosis. I am not doing a section on malaria or TB in this year’s
letter, but there has been good progress in both diseases, with the
Global Fund being key to this.
Zabibu Athumani and her son rest under an insecticide-treated bednet
(Bagamoyo, Tanzania, 2011).
The Global Fund does a lot to make sure its money is spent
efficiently. Given the places where the Global Fund works, it is not
surprising that some of the money was diverted for corrupt purposes.
However, the Global Fund found these problems itself and changed the way
it handled training grants, where most of the problems were.
Unfortunately, news of any corruption makes many citizens think the
entire program is mismanaged and a huge portion of the money is being
wasted. Some of the headlines that talked about two-thirds of specific
grants being misdirected fueled this impression. In fact, less than 5
percent of Global Fund money was misused, and with the new procedures in
place that percentage will be even lower. Our foundation is the biggest
non-government supporter of the Global Fund, committing $650 million
over the years because of the incredible impact its spending has. I am
confident that this is one of the most effective ways we invest our
money every year, and I always urge other funders to join us in getting
so much bang for our buck.
Between 2011 and 2013, assuming that all donors honor their
commitments, the Global Fund will disburse $10 billion. This is a $2
billion increase, but not nearly the $12–$14 billion that is needed and
was hoped for. Citizens of donor countries should know about the
difference their generosity has made. The cost of keeping a patient on
AIDS drugs has been coming down, and it looks like getting it to $300
per patient per year should be achievable. That will mean every $300
that governments invest in the Global Fund will put another person on
treatment for a year. Every $300 that’s not forthcoming will represent a
person taken off treatment. That’s a very clear choice. I believe that
if people understood the choice, they would ask their government to save
more lives.
Family Planning
Melinda has focused a lot of her foundation time on family health
issues, including maternal and infant health, nutrition, and family
planning. In 2012 and beyond, she will really emphasize family
planning—giving women the tools they need to plan how many children they
have and when they have them. She will be talking much more about how
having the ability to plan changes the lives of women and their families
and improves whole societies. Last year, Melinda met with mothers in
Korogocho, a slum outside of Nairobi, Kenya. She was touched by one
woman who explained why she wanted to be able to space her births
further apart: “I want to bring every good thing to one child before I
have another.”
Melinda meets with a mothers’ group in the Korogocho slum
(Nairobi, Kenya, 2011).
One amazing thing is that parents’ desire to bring every good thing
to their children can have a huge impact on national economies. Melinda
spoke at the World Bank about how developing countries have a chance to
benefit from something called the “demographic dividend.” The idea is
that as parents bring their family size down, countries can invest more
in educating young people. When those young people reach working age,
they boost productivity and economic growth. South Korea and Thailand
are two recent examples of how countries that understand and capitalize
on these principles can rapidly transform their economies.
Over the next 40 years, the global population is projected to grow
at just .8 percent per year. It just passed 7 billion and will reach 9.3
billion by 2050, according to the United Nations’ medium estimate.
However, the populations of most poor countries, which have the hardest
time feeding and educating their citizens, will more than double between
now and 2050. If we compare population by continent now and in 2050, we
see that Africa will more than double in population (from 1 billion to
2.2 billion) while Asia and the Americas will grow by 25 percent and
Europe will hardly grow at all!
Looking at the numbers at the country level gives an even starker
picture. To take just one example, Nigeria, which has the biggest
population in Africa, will grow from 163 million to 392 million—an
increase of 140 percent. This will likely make the lives of people in
that very poor country even more difficult.
Melinda and I believe, though, that if the right steps are taken—not
just helping women plan their families but also investing in reducing
child mortality and increasing nutrition—populations in countries like
Nigeria will grow significantly less than projected. Almost all the
foundation’s global programs focus on goals that will help with this.
Globally, more than 200 million women say they don’t want to have a
child within the next two years but aren’t using contraceptives. If
families that wanted to wait a longer period between births or have
fewer children had access to the right tools, two things would happen.
First, those families would have an easier time facing the challenges of
poverty. Second, as national population growth rates came down
gradually, governments would be able to better meet the needs of all
their people.
A significant number of women indicate that they would use modern
family planning tools if they were available. Unfortunately, the funding
to buy these tools, to make them cheaper, and to provide high-quality
information to poor families has been lacking.
The tools that are likely to have the highest adoption rates in
sub-Saharan Africa are implants or injectables, not the oral
contraceptives that are popular in the United States. Indonesia has made
implants broadly available, and more than 1.7 million women are using
implants today. The foundation has helped fund quality assurance for a
lower-cost implant, Sinoplant II, which is registered today in more than
17 countries and costs 60 percent less than the alternatives. We also
think that injections can be made cheaper and longer lasting and put
into a format that women can administer themselves. There are a large
number of steps required to get new tools not only approved and
manufactured but also understood so that women can make informed choices
about contraception. Our goal is that every woman should have the
ability to choose when she wants to have children. The result will be
healthier mothers and children and more prosperous nations.
U.S. Education
Our work in U.S. education focuses on
two related goals: making sure that all students graduate from high
school ready to succeed in college and that young adults who want to get
a postsecondary degree have a way to do so.
On the K-12 side, our top priority is helping schools implement a
personnel system that improves the effectiveness of teaching, because
research shows that effective teaching is the most important in-school
factor in student achievement. There are a lot of great teachers in
public schools, and a lot of teachers who want to be great but don’t
have the tools they need. If we could make the average teacher as good
as the best teachers, the benefit to students would be phenomenal.
"If we could make the
average teacher as good
as the best teachers, the
benefit to students
would be phenomenal."
- bill gates
A personnel system includes hiring; giving specific feedback;
helping employees improve; and creating pay schedules, benefit plans,
and termination procedures. There is consensus that the current
personnel system in public schools doesn’t work. Every element of
today’s system is criticized. However, there isn’t a strong consensus on
what to change. Many states are moving away from guaranteed tenure with
pay based solely on seniority and what degrees you have. But most of
the alternative measures do not include much investment in teacher
evaluation, which makes them very dependent on how good the principal is
and how well student test scores measure teaching effectiveness.
I still find it hard to believe that 95 percent of teachers are not
given specific feedback about how to improve. Even more important than a
pay schedule that rewards excellence is identifying and understanding
excellence so that teachers know how they can improve. In all the
meetings I have had with teachers around the country, and in the surveys
we have done, it is clear that most teachers want more feedback and
will use it to improve, even if the financial rewards for performance
are comparatively modest.
The most compelling example I have seen that this concept can work
in a way that is great for both teachers and students is the school
district of Tampa, Florida that Melinda and I visited this past fall. A
key element of the agreement between the teachers’ union and the
superintendent was to assign 2 percent of the teachers to become peer
evaluators. These teachers were trained to observe classroom teaching
and provide feedback on 22 different components. The principals have
also been trained in this approach. Every teacher gets in-depth feedback
from both the principal and the peer evaluator.
Students at Thomas Jefferson High School conduct an experiment in a chemistry lab
(Tampa, FL, 2011).
Tampa has been doing this for three years now, and it is already
making a big difference. Teachers told us they value having feedback
from two different sources—the principal who knows the school the best
and the peer who knows the challenges of their specific job. The first
round of evaluation revealed that many teachers need help engaging the
students to prompt critical thinking and problem solving. The district
started to organize its professional development around these findings,
and the teachers have seized that opportunity to become more effective
in the classroom.
When Melinda and I met with students, they told us that they had
seen a big change during their time at the school. The success here
required great work by Superintendent Mary Ellen Elia, Classroom
Teachers Association President Jean Clements, and all of the teachers. I
was particularly impressed with the peer evaluators. They all said they
understood great teaching far better, having done the peer evaluation
job. Some of the peer evaluators will go back to teaching and others
will go into schools of education to help make sure new teachers have
better preparation.
After seeing how valuable peer evaluation is, I think it should be
part of every public school personnel system. Dedicating 2 percent of
teachers to do this work is a large investment. It can mean raising the
average class size by 2 percent or spending 2 percent more money. With
budgets as tight as they are, most states will not add extra money for
evaluation so we will have to make the case that it is worth the small
increase in class size (of fewer than one student per class on average).
Without this investment I don’t think an evaluation system will get
enough credibility with the teachers or provide enough specific feedback
to help teachers improve. Looking at test scores is also valuable for
most subjects, but test score data mostly just identifies who is
succeeding—it doesn’t show a teacher what needs to change. I see the
willingness to make this investment as a test of whether people are
serious about an evaluation system that really works.
Accelerating the development, discovery, and use of innovative
educational technologies is another high priority for us. We have seen a
tremendous amount of progress in this area recently, but it is really
just the beginning. More needs to be done to equip teachers with the
tools and information they need to make learning more personalized and
engaging.
Social networking is one of the most promising areas, because it
helps teachers and students connect in ways that naturally augment
what’s going on in the classroom. Services that use social networking,
like Edmodo, are really starting to take off because teachers can manage
all aspects of the classroom using a platform with which most people
are comfortable.
A teacher works with her student in a school that’s partnering with Khan Academy
(Los Altos, CA, 2011).
©Khan Academy
I’m also excited to see more and more schools “flip” the classroom
so that passive activities like lectures are done outside of class and
in-class time is used for more collaborative and personal interactions
between students and teachers. Khan Academy is a great example of a free
resource that any teacher can use to take full advantage of class time
and make sure all students advance at their own pace.
Great work is also being done by companies that are thinking beyond
simply digitizing textbooks. CK-12 Foundation, Udemy, and Ednovo have
great teacher- and community–generated content. A simple example of how
powerful the community can be in this area is TeachersPayTeachers, a
marketplace that facilitates the sharing and exchanging of lesson plans
and other materials developed by teachers themselves.
We’re also just starting to see how impactful gaming can be in an
educational context. MangaHigh and Grockit are successfully delivering
fun, competitive, game-based lessons that drive greater engagement and
understanding. Zoran Popovic, at University of Washington’s Center for
Game Science, is taking this even further through some amazing work
creating games that automatically adapt to each student’s unique needs
based on their interactions with the computer.
Many of these new tools and services have the added benefit of
providing amazing visibility into how each individual student is
progressing, and generating lots of useful data that teachers can use to
improve their own effectiveness.
But how do most teachers figure out what’s available and right for
them? There’s not yet a good answer to this question. Good technologies
remain unused, and teachers spend too much of their own time and money.
That’s why I’m launching a project this year to build an online service
that helps educators easily discover and learn how to use these new
tools and resources. I think there’s no limit to what a teacher with the
right tools and information can do.
Foundation Updates
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Foundation Updates
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SECTION
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Jeff Raikes gives polio drops
(Kebbi, Nigeria, 2011).
Jeff Raikes continues to do a great
job leading the foundation as CEO. Tachi Yamada, who ran our Global
Health program, and Sylvia Mathews, who ran Global Development, moved on
to other jobs, and we thank them for their great contributions. Jeff
recruited Trevor Mundel to run Global Health and Chris Elias to run
Global Development. We are very excited about the experience and talent
they bring to the foundation. Our third group, the U.S. Program, which
focuses primarily on our U.S. education work, continues to be ably run
by Allan Golston.
My dad speaks to the construction team during an opening celebration of our new campus
(Seattle, WA, 2011).
In June the foundation moved to a new campus. The campus is designed
to facilitate collaboration, including space for meetings with lots of
partners on key foundation topics. Melinda worked closely with the
architecture firm NBBJ to mold the design to fit our work. Already our
employees are seeing the benefit of being in one location where they can
collaborate with each other more easily, and they say they really value
being able to convene grantees and other partners on site.
My father, William Gates, co-chair along with Melinda and me,
continues to provide inspiration and guidance for a lot of our work. In
June, he gave a speech to 10,000 Lions Club members who gathered in
Seattle for their annual convention. The streets were closed for their
parade, and then my dad spoke about the Lions’ impressive work fighting
measles. Ten years ago, 2,000 people died from measles every day. Now,
that number is down to 500. My father, who has always encouraged me,
loved encouraging an arena full of people to keep saving children’s
lives.
Giving Pledge
The Giving Pledge, which entails wealthy individuals and families
making a simple pledge to give away a majority of their wealth during
their lifetime or in their will, has already grown to 69 people, which
is more than we expected when we started. As we began 2011, we heard
from several people who said they plan to take the pledge very soon.
We’re hopeful that many others will follow. It’s inspiring to read
people’s rationale for making the pledge; you can find their letters at
www.givingpledge.org.
We brought the group of pledgers together in May for the first of
what will be an annual gathering to learn from each other. The event was
a great success. A lot of people found they had goals in common, so
even as the Giving Pledge celebrates the diversity of giving, it has
helped spur collaboration. We’re starting to see the fruits of that
effort, as members of the group are now looking at co-funding projects.
Warren, Melinda, Azim Premji, and I talk about philanthropy
(Delhi, India, 2011).
When Warren Buffett, Melinda, and I were in India in March, we sat
down with around 60 wealthy families to hear from them about Indian
philanthropy and share our experiences. Azim Premji, one of the pioneers
of philanthropy in India, joined us for the panel discussion. Warren’s
energy and humor were in strong evidence. When talking about whether it
would be better for the wealthy to use their money to create jobs,
Warren noted that even Santa Claus creates jobs by employing the elves
and reindeer!
One thing that really struck me in both the Giving Pledge meeting
and the India get-together is that a key factor holding people back from
being even more generous is finding philanthropic endeavors that make
them feel like they are having a significant and unique impact. It has
me thinking a lot harder about how we can use the web to make it easier
for givers of all sizes to connect to causes and see the results of
their giving.
Why I’m Optimistic
Early in 2011, President Sarkozy of France invited me to write a
report for the G20 and present it in person at their November meeting in
Cannes. This was a huge honor, since it is the first time a
philanthropist has been asked to speak to this group. The organizers
weren’t even sure what country to put on my badge since I wasn’t coming
as part of the U.S. official delegation. They decided to put “Invitee”
on my badge, making me briefly the head of government of Invitee!
Speaking with French president Nicolas Sarkozy before a plenary session of the G20 Summit
(Cannes, France, 2011).
©AP, Charles Dharapak
My report focused on how the G20 can help ensure that the poorest
are not forgotten, as rich countries deal with significant economic and
budget challenges. The report, “Innovation with Impact: Financing 21st
Century Development,” is on gatesfoundation.org. It starts by describing
how much life has improved for the poorest over the past 50 years. Part
of the reason is the aid contributed by rich countries. A lot of media
attention focused on my suggestions of a modest financial transaction
tax, increased tobacco taxes, and a carbon tax to support aid
commitments. None of these ideas has universal agreement, and none will
solve the problem alone, but they can make a big difference if even just
a few countries adopt them.
Overall, however, I tried in the report to paint a picture of the
incredible diversity of resources available for development. It’s not
just rich countries giving aid that are having an impact. I described
what poor countries themselves are doing to speed their own development;
I pointed out how rapidly growing countries like Brazil, China, and
India are bringing new experience and expertise to development; and I
discussed some ways in which the private sector can get involved in
improving the lives of the poor and helping countries develop. I am
excited because innovative partnerships that capitalize on the
comparative advantages of all these players can accelerate progress,
speeding the transition beyond aid for many poor countries.
"We are convinced that when
people hear stories of the lives
they’ve helped to improve,
they want to do more, not less."
- bill gates
The G20 conference itself was a microcosm of the challenges that
leaders face, with the Eurozone crisis taking a lot of their time. I was
impressed that the leaders took 90 minutes to discuss my report and
related issues, and I hope they will set aside time for development when
they meet in Mexico for next year’s summit.
Following my presentation, a number of the leaders shared specific
suggestions for addressing these issues. David Cameron said it would
make his country’s leadership on giving .7 percent of gross domestic
product by 2013 in tough times easier if more countries would do the
same. I got the strong impression that the leaders themselves are very
sympathetic to the case that aid budgets should not be cut even as
governments reduce their spending. However, this will be possible only
if their constituents understand that aid, which is less than 1 percent
of the budget in most countries, has a significant impact on people’s
lives. I have tried in this letter to make that case. Whether it’s
fighting plant disease, treating people with AIDS, or getting a measles
vaccine to a child in a remote area—modest investments in the poorest
make a huge difference.
Unfortunately, many people believe the opposite—that money spent on
development is wasted, or that it doesn’t get lasting results. Melinda
and I will spend a lot of time in the coming year explaining why they’re
mistaken. The relatively small amount of money invested in development
has changed the future prospects of billions of people—and it can do the
same for billions more if we make the choice to continue investing in
innovation. We will repeat that message over and over in our speeches
and interviews, and on gatesfoundation.org and gatesnotes.com, because
we are convinced that when people hear stories of the lives they’ve
helped to improve, they want to do more, not less.
Bill Gates
Co-Chair, Bill & Melinda Gates Foundation
January 2012
