May 17, 2011 | By Bill Gates
A Commitment to Global Health
My prepared remarks to the World Health Assembly in Geneva.
The World Health Organization and this assembly have set the standard for global cooperation in pursuit of better health. For decades, you have established ambitious goals, such as eradicating smallpox. And you have rallied the world to accomplish those goals. It is an honor to join you today.
I had the privilege of addressing this assembly in 2005, when my wife Melinda and I were still new to global health. In my speech, I described why we were so optimistic about the future. The world was finally starting to use its greatest resource—innovation—to solve its biggest problem—the fact that billions of people don’t have the chance to lead a healthy, productive life.
In the past six years, my optimism has only grown.
An important new book by the economist Charles Kenny makes a strong case that life is getting better—rapidly—for people in poor countries. To build his argument, he examines a series of key quality-of-life indicators, including child survival, school enrollment, and levels of violence.
I hope Mr. Kenny’s book, which is called Getting Better, gets the acclaim it deserves. It proves that the great work this assembly has been leading is having an enormous impact. As long as the people who make funding decisions and set policy understand the progress being achieved every day, I believe we have the opportunity to make even more progress—faster—for more people.
This opportunity is the reason I started working full time at the Gates Foundation. Health and development is the most urgent, most rewarding work I can think of, and Melinda and I will devote the rest of our lives to it.
When I was a teenager, I was captivated by computers because I believed they would change everything. I couldn’t predict exactly what the future would look like, but I was overcome by a sense of possibility.
Over the years, as I watched so much change taking root, I also saw glimpses of what was not changing. In 1994, I travelled to sub-Saharan Africa. It was impossible to ignore the devastating impact of disease and poverty on people’s lives.
Then, in 1998, Melinda and I read an article about rotavirus. We learned that it was the leading cause of diarrhea in young children—and that it caused 500,000 deaths annually in poor countries. Our first child had just been born, and there was a good chance she’d suffered from rotavirus. But in the United States, children don’t die from diarrhea.
We’d never been forced to reckon with rotavirus—in fact, we’d never even heard of it—because there was no chance our daughter would be killed by it.
This was a sobering realization for me. I had built my life around the idea that innovation is for everyone. When I began to understand how billions of people are deprived of its benefits, it made me angry. I decided to use my personal wealth to help confront that inequity.
Thirty years ago, my colleagues and I envisioned a computer on every desktop. Now, I join you in seeking access to good health care for every human being.
At the Gates Foundation, our goal is to spur innovation on the specific health problems poor people face.
Our priorities are your priorities—to make motherhood safer; to ensure that newborns survive their first weeks of life; to provide children with a nutritious diet.
We see what you see—that diseases like HIV, tuberculosis, and malaria are destroying communities. Along with great partners like the Global Fund, we want to help you diagnose, treat, and—above all—prevent disease.
As we think about how to deploy our resources most effectively, one intervention stands out: vaccines.
Today, I would like to talk about how you can provide the leadership to make this the Decade of Vaccines.
Vaccines are an extremely elegant technology. They are inexpensive, they are easy to deliver, and they are proven to protect children from disease. At Microsoft, we dreamed about technologies that were so powerful and yet so simple. Today, I like to imagine what the future will look like when world leaders start using vaccine technology to its utmost.
Let me describe the future I see.
Early in this decade, we will eradicate polio.
By the end of the decade, five or six new vaccines will be available to all countries at prices they can afford to pay.
And, crucially, every country in the world will have built a system to deliver vaccines to every last child.
To put an end to polio and reach all children with new vaccines, we must create strong immunization programs.
In January of last year, I called for the world to accelerate progress on vaccines. That was a moment, and now there is momentum. I’m excited that global health leaders are now collaborating to put a specific global vaccine action plan in place.
The success of that plan—and the success of the Decade of Vaccines—will depend on all of you.
The greatest asset of every country is the energy and talent of its people. Disease saps that energy and squanders that talent. Repeated intestinal infections stunt children’s growth and impair their cognitive development. Meningitis can cause permanent neurologic disability. Malaria prevents people from working for long stretches; over a lifetime, high rates of malaria are correlated with significantly reduced earnings.
That’s why vaccines are one of the best investments we can make in the future—healthy people build thriving economies. Freeing billions of people from the relentless burden of sickness and death will unleash more human potential than any other revolution in history.
Let me give you an example of the difference vaccines can make.
This year, 20 million children will contract severe pneumonia. More than a million will die. But even when the disease doesn’t take a child’s life, it can steal a family’s future.
For the survivors, the bout of sickness will reduce their chances of growing up healthy and strong. Their parents will go into debt to pay for health care. But we now have vaccines against two of the leading causes of pneumonia. These vaccines will make it possible for countries to tap into people’s energy and nurture their talent.
The pneumonia vaccines are a symbol of one of the most exciting trends in global health, the drive toward equity in creating and delivering innovations.
In the past, drug companies developed vaccines for rich countries, and it took more than a decade before they were introduced in poor countries. But that is changing.
The newest pneumonia vaccines were available in developing countries just a few years after they were approved for use in developed countries. The same is true of a new rotavirus vaccine. But approved and available don’t mean delivered. Now it is up to the GAVI Alliance and many of you in this room to ensure that these vaccines reach the children who need them.
Last December, Burkina Faso, Mali, and Niger made history when they introduced a brand new vaccine for Meningitis A—the first vaccine developed specifically for Africa.
The story began in 1996, when the deadliest meningitis epidemic in memory tore through 25 countries in Africa, infecting more than 250,000 people. Meningitis strikes with frightening speed. A perfectly healthy child can be playing with friends one minute and be dead in a matter of hours.
In 1996, the only weapon against meningitis was scarcely a weapon at all—a short-lasting vaccine that wasn’t effective among young children. Health officials used it to control outbreaks that were already raging, so they called it “medicine after death.” They demanded a better vaccine that could prevent outbreaks in the first place.
The WHO and an organization called PATH formed the Meningitis Vaccine Project in 2001. The partners set a target price of 50 cents for the vaccine. At that price, health officials said, they could afford to introduce a meningitis vaccine as part of their national programs.
But producing a vaccine at that low price required a new approach to drug development. The Meningitis Vaccine Project worked with a Dutch biotech company to obtain key raw materials and arranged a technology transfer from the United States Food and Drug Administration. Then, the Serum Institute of India agreed to manufacture the vaccine at the target price.
I am pleased to announce that we now have very early results from Burkina Faso. In the first 16 weeks of this year, there was just a single case of meningitis reported in the country.
Because of the way meningitis spreads, it’s too soon to declare victory, but the data makes me hopeful. For centuries, meningitis terrorized a region of 400 million people. This vaccine can help end the terror.
We need to continue creating and delivering more vaccines, but finally, for the first time, we have every reason to expect progress. A bleak picture has turned bright.
To keep the promise of equitable access to health care, all new vaccines must be priced low enough so that all countries can afford them. The Gates Foundation is working with many vaccine manufacturers to ensure that vaccines are available at a reasonable price. I am confident that we can cut the combined price of the pentavalent, pneumococcus, and rotavirus vaccines in half by 2016.
But even when prices are fair, delivering vaccines to every child takes an unwavering commitment.
Many developing countries are already doing a great job. Bangladesh, Nicaragua, Rwanda, and Vietnam routinely vaccinate about 90 percent of their infants each year. But there are places where children never get a single vaccine. Almost every country can do better—must do better, if this decade is to become the Decade of Vaccines.
Leading a health ministry is a hard job. You face a multitude of complicated choices. The stakes are always life and death. And you never have enough resources.
But you all have access to one key resource: your own leadership. And leadership can be decisive. The best immunization systems work because leaders hold themselves accountable for results. They diagnose problems, innovate to solve them, and spread the best ideas.
Let me give an example. Just a few years ago, the Indian state of Bihar was vaccinating about 30 percent of its children. Then, a new chief minister, Nitish Kumar, was elected, and he made it clear that he expected significant improvement.
Bihar is still one of the poorest places in the world, but it’s no longer one of the least vaccinated. Under Chief Minister Kumar, the vaccination rate has more than doubled, and it’s still climbing.
I visited with Chief Minister Kumar two months ago, and his mastery of the immunization situation in his state was impressive. He understood the innovations that were being tested. He knew what was working, what wasn’t, and why.
I was also struck by the chief minister’s popularity. People are hungry for visionary leaders who not only promise a better future, but deliver upon that promise.
Today, I ask for your leadership. In 2005, you set two critically important immunization-related goals that we have not yet reached.
Let us renew our pledge that no country will be below 90 percent coverage. Let us rededicate ourselves to the idea that no district will be below 80 percent coverage. We will meet those goals if—and only if—you lead. When you do, you will make this the Decade of Vaccines.
As a global health community, it is imperative that we shine a light on the countries doing the best work. We need to know who the innovators are, so that the most powerful ideas spread far and wide.
Starting in 2012, the Gates Foundation will bestow an award on the individual or organization that has made the most uniquely innovative contribution to the Decade of Vaccines. This could be innovation in the science, delivery, or funding of vaccines. I will announce the winner every January in my annual letter. My goal is to make sure that pioneering global health leaders get the credit they deserve.
The long fight against polio proves just how powerful vaccine technology can be, but it also demonstrates that technology is only as effective as the leaders delivering it.
Twenty-three years ago, here in this building, the delegates to this assembly resolved to wipe polio off the planet. And now we’re 99 percent of the way there, because of two things: A 13-cent vaccine so easy to administer that even I have done it many times—and the biggest, farthest-reaching delivery effort global health has ever seen.
Since 1988, we’ve taken more than 100 countries off the polio map. In the most difficult conditions in the world, we are making stunning progress. Despite the ongoing war, Afghanistan has had only one case this year.
But progress is not the same as success, and eradication is not guaranteed. We have proven tools—diagnostics, surveillance systems, and vaccines that are constantly being improved—but the virus keeps spreading back into countries where it had been eliminated. There are countries where the virus continues to circulate, despite multiple campaigns every year. Globally, the polio program is not assured of funding to keep running campaigns and improving vaccination systems.
These discouraging facts raise a question: Do we really have the political commitment to eradicate polio?
Are donor countries, especially the G8, ready to close today’s funding gap and see the job through to the very end?
Are the countries where polio is still a threat ready to take extraordinary action to reach every single child with the vaccine?
We have a choice. We can keep doing what we’ve been doing, immunizing the same children over and over and missing the children who are the most vulnerable. Or we can do more. We can step up our fundraising, we can intensify our campaigns, and we can do what it takes to get to zero cases. If we make that choice, we will prove that people are capable of coming together to solve complex, worldwide problems.
The eradication of polio will be a great victory for the World Health Assembly. You started the courageous fight against this disease. You will finish it. And then you will be able to move on to the next ambitious goal.
One of the polio leaders I respect most is Dr. Muhammad Pate, who directs Nigeria’s national eradication effort. Just a few years ago, Nigeria was the most troublesome spot on the polio map. It had hundreds of cases. Much worse, it lacked the commitment to bringing that number down.
But Dr. Pate, along with the global polio partners, President Goodluck Jonathan, and members of the ministry of health, helped rally government and traditional leaders around the cause. Dr. Pate told me that his agency makes a point of identifying poor-performing states publicly. That’s the kind of accountability that leads to results. Last year, thanks to a nationwide effort, polio was down 95 percent in Nigeria. Nigeria’s leaders still have a lot of work ahead of them, but they have turned the polio program around.
During my last visit to Nigeria, Dr. Pate asked me a small favor. He hoped I’d be willing to sign his daughter’s school yearbook. I was more than willing, of course, and I want Dr. Pate’s daughter to know this: I admire her father very much, I want to introduce my children to him one day soon, and I hope more than anything that when that day comes there will be no more polio in Nigeria.
The world has a precious opportunity right now, and whether or not we seize it will depend in large part on those of us in this room. It will depend on our ability to do the difficult, necessary things to usher in the Decade of Vaccines.
Donor countries, you must increase your investment in vaccines and immunization, even though you are coping with budget crises. The GAVI Pledging meeting next month gives you and your governments the opportunity to show your support. If donors are generous, we will prevent 4 million deaths by 2015. By 2020, we can prevent 10 million deaths.
Pharmaceutical companies, you must make sure vaccines are affordable for poor countries. Specifically, you must make a commitment to tiered pricing.
All 193 member states, you must make vaccines a central focus of your health systems, to ensure that all your children have access to existing vaccines now—and to new ones as they become available.
At the Gates Foundation, we are committed to working with all our partners—civil society, donors, drug companies, and national governments—to help you do the difficult but necessary things.
I am confident because I’ve seen so many examples of leadership.
British Prime Minister David Cameron passed the toughest austerity budget in his country’s memory. Yet, in the face of enormous pressure, he kept his promise to maintain development spending. A few months later, he announced that the United Kingdom would double its commitment to polio eradication.
The Serum Institute of India, led by Dr. Cyrus Poonawalla, has broken the mold for the low-cost manufacture of vaccines. They developed the meningitis vaccine, they are the world’s largest producer of the measles vaccines, and they provide the pentavalent vaccine to GAVI at a lower price than any other manufacturer in the world. In the coming years they will manufacture inexpensive diarrhea and pneumonia vaccines.
Nitish Kumar and Muhammad Pate have demonstrated that the best leaders can overcome the worst circumstances.
Together, and with your leadership, we can make this the decade in which we take full advantage of the technology of vaccines. When we do it, we will build an entirely new future based on the understanding that global health is the cornerstone of global prosperity.
It might be the most difficult thing we’ve ever done, but it will also be the most important.