Global Health Insights from the 2015 Gates Annual Letter

-Written by Adenike Onagoruwa, PhD (Contact: adenike.onagoruwa@gmail.com)

For the seventh consecutive year, Bill and Melinda Gates have released an annual letter, discussing the Gates Foundation’s activities and sharing progress on the fight against poverty and disease. An organization headed by two of the world’s most powerful philanthropists, the Gates Foundation funds global health, development and advocacy efforts aimed at reducing poverty and eradicating preventable diseases that disproportionately affect the developing world population.

Through its grant-making and operational activities; the Foundation has, especially in the past decade, set the health agenda for aid organizations, research institutes and even governments around the world. It is therefore quite important to pay attention to the insights, priorities and goals outlined by these primary players in the global health and development arena. With the upcoming expiration of the Millennium Development Goals (MDGs), this year’s letter evinces the momentousness of 2015.

Released at the start of the year, the 2015 Gates Annual Letter titled “Our Big Bet for the Future” makes ambitious predictions regarding the next 15 years. The big bet is this: “The lives of people in poor countries will improve faster in the next 15 years than at any other time in history. And their lives will improve more than anyone else's.” Acknowledging the absurdity of this bet in the face of seemingly worsening world problems (they do add a caveat that a handful of the worst-off countries will continue to struggle); the two give these reasons why they think there has never been a better time to accelerate progress, resulting in longer lives and better health:

     “There will be unprecedented opportunities to get an education, eat nutritious food, and benefit from mobile banking.”

     “These breakthroughs will be driven by innovation in technology — ranging from new vaccines and hardier crops to much cheaper smartphones and tablets — and by innovations that help deliver those things to more people.”

The key global health breakthrough they foresee happening by 2030 is that “Child deaths will go down, and more diseases will be wiped out”. Here’s how:

Cutting the number of children who die before age 5 in half again. The percentage of under-five deaths worldwide has been cut in half (1 in 10 children in 1990 to 1 in 20 today). 1 in 40 children by 2030 can be achieved by

     scaling proven, existing interventions for saving newborn lives such as: immediate and exclusive breastfeeding for the first six months; delivering injectable antibiotics immediately a baby appears ill; basic training for resuscitating a struggling-to-breathe newborn with a hand-pumped oxygen mask; immediately drying and warming the newborn after delivery through skin-to-skin contact; and topical application of chlorhexidine to the umbilical cord for prevention of sepsis specific mortality.

     Comprehensive immunization - almost all countries will include vaccines for diarrhea and pneumonia, two of the biggest killers of children, in their programs.

     Improved hygiene and sanitation to reduce disease spread - through simple hand-washing and innovative toilets specially designed for the poor.

     Leveraging on the work that has been done to strengthen country-level health systems in many poor countries.

Reducing the number of women who die in childbirth by two thirds. The number of mothers dying will go down by:

     Increasing the number of women that give birth in healthcare facilities instead of at home.

     Making sure that caregivers at healthcare facilities are well-supplied and well-trained.

     Improving access to contraceptives and to information about pregnancy spacing.

Wiping polio and three other diseases off the face of the earth. Polio, elephantiasis, river blindness, and blinding trachoma can be eradicated by 2030 through:

     Free medicines made possible by continuing donations from pharmaceutical companies.

     Strategic delivery of these medicines aided by advances in geographic information systems for disease surveillance.

Finding the secret to the destruction of malaria. While the two are not optimistic about the elimination of malaria by 2030, they believe that all the tools for its complete eradication will be available by then. By 2030, based on early versions of these tools currently in development, it is anticipated that:

     There will be a vaccine that will prevent the transmittal of the malaria parasite from infected persons to the mosquitoes that bite them, thus halting the spread of the disease.

     There will be a single-dose cure that will completely clear the parasite from infected persons.

     There will be a diagnostic test that can provide immediate results on infection status.

Forcing HIV to a tipping point. Alongside efforts to develop a vaccine or cure for HIV, HIV will be forced to a tipping point globally when:

     The number of people beginning anti-retroviral treatment in sub-Saharan Africa surpasses the number of newly infected people.

     The high HIV transmission rate in sub-Saharan Africa is arrested, leading to a worldwide reduction in HIV cases.                 

Progress towards these health breakthroughs will be complemented by parallel progress in agriculture (innovations to increase yield and improve nutrition content in order to increase earnings and reduce malnutrition); education (the creation of better technology to revolutionize learning, make online education easily accessible and reduce the gender literacy gap); and banking (increased access to mobile banking that gives the poor more control over their finances, makes transactions more efficient, less time consuming and makes it easier to borrow and save).

What does this letter mean to the health and development community? Well, as one of the biggest funders, the letter provides a projection of what we can expect to see in global health programming in the years to come. For instance, there will be an emphasis on scientific and technological discoveries aimed at reducing maternal and child mortality. Organizations working to develop vaccines as well as rapid, low-cost diagnostic tests and medical devices will receive priority funding. Just as the MDGs have been used as a framework for driving actions and policies in development, the goals outlined in the 2015 Gates Letter will certainly have impacts on programs and policies in many developing countries, as well as on the funding directions of other donor agencies.

The master plan of the Gates touches on several vital issues that are central to health and development and is sensitive to the gender applications and implications of proposed activities. It galvanizes public engagement with the introduction of a “Global Citizens” program that invites and provides a platform for “global citizens” to “lend their voice, urging governments, companies, and nonprofits to make these issues a priority”. Certainly, their big bet can only be attained by building collaborations within existing structures and breaking down walls between nonprofit sectors. Monetary and R&D investments by the private sector coupled with international political support will be paramount for achieving any progress. Political will and better bureaucracy at the country level is a huge determinant of success. However, it is noted that the letter does not focus much, if at all, on the development of structures that sustain interventions such as legal, policy, financial and governmental environments. The focus is rather on straightforward solutions that can be achieved while bypassing these systems and institutions.

All-in-all, the letter provides a credible, multi-sectoral agenda and it is hoped that the Post-2015 Sustainable Development Goals will be as practical as the 2015 Gates Annual Letter in providing achievable goals for improving global health in the next 15 years.

References:

Bill and Melinda Gates. 2015 Gates Annual letter. www.gatesnotes.com/2015-annual-letter