In 2015, 193 world leaders agreed to 17 ambitious goals to end poverty, fight inequality, and stop climate change by 2030. Seven years in, the world is on track to achieve almost none of those goals, according to a new report from the Bill and Melinda Gates Foundation.
But the world really is getting better, the founder and philanthropist Bill Gates tells Derek in this episode. Around the globe, poverty, hunger, and child mortality rates are falling. Income, health care coverage, and lifespans are growing. Bill and Derek talk about the “best news in the world,” why genetics is the most exciting domain in all of science, and how Gates is helping to build the future of food in Africa.
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Derek Thompson: Let’s begin with your Goalkeepers Report, which looks at some key measures of human progress around the world. One of the themes of this report is that we live in an age of crisis, whether it’s inflation here in the U.S. or war abroad, but that sometimes crisis can force people to do things that reroute the future. And one example in your report is AIDS. At the beginning of the century, it was projected that in 2020, 5 million people would die from AIDS. In fact, that number was many times smaller than the projection. What is the key lesson that you want people to take from this dramatic shift toward progress in the HIV-AIDS epidemic?
Bill Gates: Well, it’d be easy in the face of all these challenges to sort of turn away from thinking about Africa and the challenges there. We have electricity price increases, inflation, all sorts of things that have us turning a bit inward. And yet the level of generosity that’s considered great is 0.5 or 0.7 percent of GDP. So a fairly small percentage. Because those dollars are so impactful, whether it’s buying better seeds or buying HIV medicine, we’re innovating these costs so that in the health field, we’re saving lives for a thousand dollars per life saved, which is very different than rich-world medicine that would be willing to spend a million dollars per life saved. So we’re not saying, “OK, everything we have, everyone can have.” Maybe 50 years from now, we can say things like that. But here we’re just talking about the basics of survival and avoiding malnutrition.
So I am optimistic that if we don’t turn away, that if we fund the R&D, if we fund the delivery systems, that we’ll get back on track. The world has this report card called the Sustainable Development Goals, which is where we should be by 2030. And because in 2015 when we set those goals, we didn’t expect a pandemic, we didn’t expect a war in Ukraine, and we were a little aspirational in some of the goals, if you look at that report card, you’d be like, “Wow, maybe I should drop out.” But this is about millions of lives.
And so every year, the foundation puts out the Goalkeepers Report, and usually it’s about half things that we’re doing well on and about half things we’re behind on. Sadly here, we took food in particular and gender as two things, to get into some examples where things are going well, but the overall picture is very challenged. And yet because of the progress before the pandemic and because of the innovation, including new vaccines, using mRNA, and the new seeds we’ve been talking about, I remain optimistic when I think of the 10-to-20-year time frame.
Thompson: So your review of the 2015 Sustainable Development Goals had a lot of bad news because it’s been a really tough two years with war, the pandemic. I want to ask you about one piece of good news here. And I think it might be the best piece of news on the planet in the last 30 years. It is the share of newborns and children who die before the age of five. That number has declined since 1990 by 50 percent. How did this happen?
Gates: The biggest reason why that number’s gone down is that we got the vaccines out to almost all of the children in the world. And so this group called Gavi that was created near 2000 is helping buy those vaccines and the prices have gone way, way down. So that’s now affordable. So you have a diarrheal vaccine, a pneumonia vaccine. Then couple that with the Global Fund, which is also created at the same time and focuses on HIV, TB, and malaria. Malaria mostly kills young kids, and that’s where we invent these new bed nets and we keep those bed nets up to date. And so, yes, it’s a combination of somewhat better nutrition and economic progress, but over half is delivering, not just inventing, but delivering through the primary health care system, even in the poorest countries, quite a few new vaccines. So that statistic, I think the world should be very proud of. All the donors who are involved. Our foundation is a piece of that, but it’s the reason why keeping these foreign aid levels at what is considered a generous level is such a moral cause.
Thompson: You mentioned Gavi, and for those that don’t know, Gavi is a public-private global health partnership that buys and distributes vaccines to people around the world; most importantly, children who are vulnerable to diseases like measles and pneumonia. Bill, you have this penumbral view of the scientific frontier. What is the one domain of science that you are most excited about right now?
Gates: Our ability to understand genetics, to sequence, to edit, that has for many diseases, like perhaps curing HIV or sickle cell, which is present everywhere, but mostly in Africa. Those things are super expensive, but we have a way that over the next decade, we think we can get that down to a single shot that’s less than a thousand dollars. And so the excitement of the scientists to take it from a million dollars to cure sickle cell or HIV down by a factor of a thousand. It’s great to see the number of pathways and ideas, and I love working with those scientists and giving them the resources to go full speed ahead.
Thompson: Your report this year goes deep on a topic that’s been all over the news recently, but that I’ve always wanted to know more about. And that is the future of food. Your organization’s working with some really cool companies and groups in this space of agriculture tech. The entire world got a lesson in food security this year. The war in Ukraine is clearly contributing to a burgeoning food crisis in Africa and Asia. And I think it’s worth starting here with a pretty basic question: Why did a crisis in Europe threaten to starve millions of people thousands of miles away in sub-Saharan Africa?
Gates: Well, sadly, Africa is a significant net food importer. And so they’re buying these crops on the world market and they’re also buying the fertilizer on the world market. And so when you have less fertilizer getting out, or the price of natural gas going up, which is a key ingredient for fertilizer, then the price goes up and some farmers just can’t afford that.
We also have the climate change weather, which now is creating more droughts, including a very big one in the Sahel region in Africa right now. And so Africa has such low agricultural productivity, about a quarter of what rich countries have. And so when you get weather setbacks or fertilizer costs going up, what you see is a dramatic increase in malnutrition and even in some areas actual starvation.
This excerpt was edited for clarity.
Host: Derek Thompson
Guest: Bill Gates
Producer: Devon Manze