TIME global health

Over 46 Million People Now Have Dementia Worldwide

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Dementia is often caused by Alzheimer's Disease

More than 46 million people around the world suffer from dementia, according to a report released Tuesday.

The World Alzheimer Report, published by Alzheimer’s Disease International and King’s College London, says the number of people affected by dementia has increased quickly from the 35 million estimated in 2009, and researchers warn that number could double in the next 20 years.

Dementia is a collective term for progressive, degenerative brain syndromes affecting cognitive functions. Alzheimer’s disease is a common cause of dementia.

The report also noted that 58% of all people with dementia reside in developing countries. By 2050, 68% of those with dementia will be located in low and middle income countries, where services are limited and populations are aging quickly.

There is no cure for dementia.

TIME health

At Least Donald Trump Started a Conversation About Menstruation

It's a global health problem that needs attention

Donald Trump did the girls and women living in developing world a great favor this week. He got menstruation – the taboo of all taboo words in polite society – onto the front page of the Sunday New York Times. That doesn’t happen every day. In fact, it’s quite possible that hasn’t happened more than a few times since the newspaper was founded in 1851.

Trump’s comment about Fox News anchor Megyn Kelly that she “had blood coming out of her eyes, blood coming out her wherever” was offensive. But it brought the topic of menstruation to the forefront of our daily conversation – at least for a media nanosecond.

So let’s use this moment to have a serious discussion about it.

Every single day, girls around the world get their menstrual periods for the first time, and many of them living in Africa, Asia and Latin America lack adequate information, guidance and support about what is happening to their bodies. Many of these girls see menstrual blood on their underwear for the first time and think they are dying or seriously ill, but are too afraid, embarrassed or ashamed to ask for help.

Menstruation is a real bona fide health issue. It’s not an afterthought of child development or insignificant to a growing girl’s sexual and reproductive health.

If girls don’t have resources for proper menstrual hygiene management (MHM) like practical information, a safe and private place to change a menstrual cloth or pad and water for washing at school, they may miss class, or stop going entirely. Decades of evidence indicate that educating girls improves the overall health of their communities.

But the ongoing taboo around talking about periods makes it hard to find solutions to the challenges girls in low-income countries face. It also hinders the global efforts to address these challenges and bring menstruation into the realm of global health and development.

A period is a scary thing when you don’t know what it is

Since 2004, my colleagues and I have been exploring the topic of menstruation in low-income countries of the world (Tanzania, Ghana, Ethiopia, Cambodia and Pakistan) and conducting research on the problems girls face the first time they get their menstrual period and then have to manage in girl-unfriendly (or rather, menstrual-unfriendly) school environments.

We have found girls who think they are dying or have a serious illness the first time they get their period. We have talked with girls who have to leave school in the middle of the day in order to find a private, clean space to change their sanitary materials.

Other girls have reported the difficulty of getting practical guidance on how to manage their periods with predominantly male teachers in the school or female teachers who are too shy to talk about such a taboo topic.

For a girl who might feel embarrassed or ashamed about her period, sitting in a classroom where boys and girls sit very close together at one desk may raise fears about menstrual blood odor.

Some schools may have rules that require children to stand up when answering questions (what if there is a bloodstain on your clothing when you stand up?). As one rural Ethiopian girl reported:

My menstruation started when I was in class and everyone started to laugh. This is the reason that I stopped going to school.

Many of the schools in the countries where we have done research, especially in rural areas, predominately have male teachers. How many girls would feel comfortable asking a male teacher to be excused? And what if the school lacks adequate toilets and water?

It’s not easy to participate in class when there is no place to change a cloth, a pad or other material to get through the school day. This is the case in about 50% of the least developed countries in the world. Or as one girl in the Philippines reported in an Emory University and UNICEF led study on MHM there:

I want to have a CR [bathroom] just for girls, girls who are menstruating separate from the boys…Because the boys might see a blood stain on the toilet bowl.

There is a growing body of research that highlights the seriousness of this problem. Colleagues at other universities, at UNICEF and at many nongovernmental organizationshave also been exploring this issue in other countries.

UNICEF, UNGEI (the UN Girls Education Initiative) and the Canadian government, for example, are supporting a 12-country research project to document the menstrual hygiene management barriers that girls face. Their motivation is that millions of vulnerable girls in low-income contexts need to be healthy and educated: their gender should not impede participation in school.

Getting your period at school shouldn’t be a big deal

This shouldn’t be hard to solve. We just need to learn about the best solutions.

What are the most cost-effective interventions to use in school environments to make sure girls know about menstruation and other body changes? What’s the best way to improve the water and sanitation facilities for both girls and female teachers? What’s the most effective way to assure there are affordable sanitary cloths, pads or other materials available to girls?

The problem is that implementing these solutions is complicated. Overcoming gender discrimination at schools that don’t provide for girls’ (and female teachers’) needs is a hurdle. Ultimately, implementing solutions depends on governments, schools, parents and donors recognizing it is an important issue – and one that can be talked about and addressed.

Teaching girls about menstruation

Although many efforts have been made to include sexual and reproductive health curricula in schools over the last decade, the topic of puberty and menstrual hygiene management in particular has often not been included.

Grow & Know, Inc, a small nonprofit that I founded, develops puberty books with girls and for girls in low-income countries in partnership with local ministries of education, UNICEF and other key stakeholders.

Our first book was designed in Tanzania, with the content then adapted through participatory research conducted with girls in new countries. Book orders have subsequently been made, for example, by the ministries of education in Ghana, Ethiopia and Cambodia.

Other organizations such as Save the Children and UNICEF are engaged in similar efforts in countries such as Nepal, Uganda and Malawi.

In parallel with this information outreach, UNICEF, WaterAid and other organizations are working in many countries – together with local institutions – to focus attention on the inadequate water and sanitation facilities in schools in Bangladesh, Zambia and Nepal.

And, finally, numerous social entrepreneurial organizations are providing more affordable sanitary materials, such as SHE in Rwanda, AfriPads in Uganda, and ZanaAfrica in Kenya.

Break the taboo

The key is to start talking openly about this issue.

As musician and Harvard Business School graduate Kiran Ghandi pointed out after running the London Marathon without a tampon:

I ran with blood dripping down my legs for sisters who don’t have access to tampons and sisters who, despite cramping and pain, hide it away and pretend like it doesn’t exist. I ran to say, it does exist, and we overcome it every day.

Menstruation is, after all, totally normal. So let’s break the taboo and not wait for the next time a celebrity starts bloviating to talk about menstruation again.

This article originally appeared on The ConversationThe Conversation

TIME global health

Amnesty International Votes to Recommend Decriminalizing Sex Work

FILE - In this Friday, May 16, 2014 file photo, a discarded bra lies on the ground outside an informal bar that allegedly employed sex workers after a government raid on the illegal mining camp in La Pampa in the Madre de Dios region of Peru. Amnesty International approved a controversial policy Tuesday, Aug. 11, 2015 to endorse the de-criminalization of the sex trade, rejecting complaints by women’s rights groups who say it is tantamount to advocating the legalization of pimping and brothel owning. (AP Photo/Rodrigo Abd, File)
Rodrigo Abd—AP A discarded bra lies on the ground outside an informal bar that allegedly employed sex workers after a government raid in La Pampa, Peru, on May 16, 2014.

Argues that laws that stigmatize sex workers violate human rights

In a landmark decision Tuesday, Amnesty International voted to recommend the full decriminalization of sex work and prostitution in order to protect the human rights of sex workers.

The resolution recommends a policy that would decriminalize all aspects of adult, consensual sex work, while still classifying coercion into sex work or having sex with a minor as a major human rights violation. The resolution is intended to protect adult sex workers from stigma and abuse by decriminalizing aspects of sex work including buying sex, pimping and operating a brothel.

“Sex workers are one of the most marginalized groups in the world who in most instances face constant risk of discrimination, violence and abuse,” said Amnesty International Secretary General Salil Shetty in a statement. “Our global movement paved the way for adopting a policy for the protection of the human rights of sex workers which will help shape Amnesty International’s future work on this important issue.”

Amnesty International doesn’t have the power to make or enforce laws, but as an international human rights organization Amnesty has been influential on some issues like lobbying against the death penalty and getting political prisoners released.

Amnesty says the new policy on sex work was based on research from the World Health Organization, UNAIDS and UN Women.

But some are not happy with the idea of decriminalizing all aspects of the sex trade, arguing that the move would expand the sex industry, and sex trafficking would grow with it. Critics agree with Amnesty that sex workers themselves shouldn’t face legal consequences, but argue that pimps and sex buyers should.

“By calling for the decriminalization of all facets of commercial sex, including sex- buying, pimping, and brothel-owning, Amnesty is saying they value the rights of exploiters over the exploited,” says Ian Kitterman, policy specialist for Demand Abolition, a group that aims to abolish sex trafficking by ending the demand for paid sex, in a statement. “I fully agree with their belief that more must be done to protect those sold in the sex trade, but it’s equally critical to hold accountable sex buyers, pimps, and traffickers who perpetuate this predatory industry.” He added that many people in sex trade are not there by choice, but by manipulation, coercion or lack of options.

Former President Jimmy Carter sent Amnesty delegates a personal letter urging them to reject the proposal on these grounds, and feminists including Lena Dunham, Meryl Streep and Gloria Steinem signed a letter to the same effect.

TIME Mental Health/Psychology

Parental Happiness Predicts If You’ll Have Another Kid

Shadow of mother lifting baby
Chev Wilkinson / Getty Images The happier a parent is after their firstborn, the more likely the child will have a sibling.

A study notes that baby number one affects parental satisfaction and, in turn, affects whether baby number two is in the horizon

It’s often said that happiness often dips for parents after the birth of a first child. The diaper changes, the middle-of-the-night wailing, the exhaustion—all this and more make for a not-so-blissful experience. Couple a crying infant with job stress and hormones, and you’ve got one crabby new parent.

And that crabbiness might mean baby won’t get a brother or a sister: New research from the Journal of Demography shows that how happy a brand-new parent acts as a pretty solid predictor of whether a couple decides to get pregnant again.

Mikko Myrskyla at the Max Planck Institute for Demographic Research in Rostock, Germany, and his colleague, Rachel Marolis at the University of Western Ontario’s Department of Sociology, collected data from Germany’s Socio-Economic Panel Study, which included the former East and West Germanys (East Germany was added in 1991), foreigners, and immigrants between 1984 and 2010. From the survey, 2,016 people who had had first births were interviewed about their levels of life satisfaction—beyond the happiness of being a parent, Myrskala told TIME.

“We don’t ask parents about happiness with relationship to parenthood, because there is a strong implicit pressure to be happy,” Myrskala says. “If I go and ask a new parent these kinds of questions, they feel a pressure to put a positive picture of what a new parent is ‘supposed’ to feel.”

Having the first kid, the authors write, is a crash course in childrearing; having a second one, then, becomes a more informed decision. This can play out in a number of ways. Consider, for instance, the parents of a fuss-free newborn. The circumstance is likely to be seen as positive experience, making the new mom and dad more likely to have more kids. About 58% of parents who reported at least a three-point loss in happiness had a second child within 10 years of the first. But that shot up to 66% of parents who did not experience a dip in happiness.

There are some commanalities among parents who decide to go for baby number two and beyond. These individuals seem to have more life satisfaction around the time of the first child’s birth, and reported a smaller drop in happiness than parents who stuck with one kid. And there’s something about being older and wiser as a first-time parent: people who are over 30 and have a college education are more likely to be able to cope with the shock of an infant than younger, less educated couples, the study found.

While the study is focused on Germany—a country that has experienced economic and political upheaval along with a 2007 parental leave amendment that made paid leave “more Nordic”—Myrskala thinks the results are in keeping with other countries.

“What this suggests is that policymakers who are concerned about lower rates should pay attention to the wellbeing of new parents,” Myrskyla says, citing not only parental leave but also affordable kindergarten and childcare.

TIME Diet/Nutrition

Here’s Who Drinks the Most Sugary Beverages In the World

Plastic cup of sugar cubes
Peter Dazeley / Getty Images How much sugar is in your fizzy drink?

Your choice may indicate your class, nationality, and sometimes even gender

It’s more likely than not that today, at some time, you’ll consume at least one beverage with sugars in it, be it fruit juice, a sweetened drink of some sort, or milk. And you wouldn’t be alone. Most everybody—as in, everybody in the entire world—likes a sip of a sweet liquid, finds a study released Wednesday in PLOS One that looks at global consumption patterns. The results are a glimpse into preferences by geography, demographic, income and even gender.

Gitanjali Singh, assistant professor at Tufts University’s Friedman School of Nutrition Science and Policy and lead author on the paper, said the researchers broadly separated beverages into three categories: sugar sweetened beverages (SSBs, for short), fruit juice, and milk. SSBs are drinks containing at least 50 calories of sugar in an 8 ounce serving (soda, energy drinks, iced teas, your morning frappe). This category also contained fruity drinks that weren’t 100% juice; that distinction was classified as “fruit juice” in this study. And milk was, well, milk.

Collecting data was a gigantic undertaking, says Singh, and took several years. But it reveals some interesting trends. Take fruit juice consumption, for example: the higher the country’s national income level, the higher the country’s fruit juice consumption. New Zealand topped the list for juice consumption, and Eritrea pulled up the rear with the least.

The same goes for milk: the richer your country, the heavier your consumption of milk. Swedes and Icelandic people clock in about 1.6 servings of milk per day, with Finns trailing not too far behind at 1.3 servings a day. Compare that to Americans, who have just 0.69 servings a day, putting it 64th out of 187 countries. South Koreans drink the least amount of milk.

East Asians tend to drink the fewest SSBs—China came dead-last—while those in the Caribbean—Trinidad and Tobago and Barbados topped the list—drink the most, especially young men, who drink 3.4 servings per day. There’s a notable age difference in SSB consumption, too: young adults prefer fizzy drinks when it comes to their sugary beverage of choice, but older adults were more into milk. And regardless of where she was from, women over the age of 65 consumed the least number of sugary beverages. At the other end of the scale were young people between 20 and 39; men in that age bracket heavily preferred sugar sweetened beverages, while women overwhelmingly went for fruit juice. (Singh warns against oversimplifying the patterns: “It’s just an average,” she says. “It doesn’t necessarily mean women prefer fruit juice and men only like milk.”)

“SSB consumption was higher in middle-income countries, but lower in low- and high-income countries,” Singh says. In other words, at the extremes of wealth, consumption of SSBs were quite low; but in countries making what Singh described as “the nutritional transition from traditional foods to more processed foods,” the number of servings of SSBs consumed daily shot up.

Why the focus on sugary drinks? Singh and her colleagues recently published another study in the journal Circulation that shows that 184,000 deaths per year around the world are linked to consumption of preventable, SSB-related diseases including type-2 diabetes.

TIME vaccines

This Is How Nigeria Beat Polio

Goodbye to all that: Computer-generated model of a poliovirus
Calysta Images ;Getty Images/Tetra images RF Goodbye to all that: Computer-generated model of a poliovirus

A quarter-century campaign brings the world tantalizingly close to eradicating a disease

It’s easy not to notice a negative. A house burns down on your block and it’s all you can talk about. But a house doesn’t burn down? Where’s the news?

Still, absence can be the stuff of headlines, and that fact has rarely been truer than it is in Nigeria today—where health officials are celebrating a full year without a single case of polio. A polio-free Nigeria means a polio-free Africa, since it was the only country left of the 47 on the continent where the crippling disease was still endemic. The virus, which as recently as 1988 was endemic in 128 countries, crippling 350,000 children per year, has now been cornered in just two places—Afghanistan and Pakistan, and it’s barely hanging on there. Wipe polio out in those last two redoubts and it will become only the second disease in history—after smallpox—to have been vaccinated out of existence.

“We are celebrating the first time ever that Nigeria has gone without a case of polio, but with caution,” said Dr. Tunji Funsho, who leads Rotary International’s anti-polio campaign in Nigeria. “Surveillance takes place in every nook and cranny of this country, even in those areas that have been free for years.”

The victory in Nigeria did not come easy—and it almost didn’t happen at all. For more than a generation, it has been Rotary that has led the drive to eradicate polio, administering vaccinations to 2.5 billion children in 122 countries at a cost of $1.4 billion. With the help of UNICEF, the World Health Organization (WHO), the U.S. Centers for Disease Control, the Bill and Melinda Gates Foundation and other groups, the effort paid off comparatively fast. As long ago as 2003, the virus had been chased out of all but six countries and the global caseload was down to just 732. There was talk of eradication by as early as 2005.

But Nigeria scuttled those plans. In the summer of 2003, Muslim clerics in the country’s northern regions halted all vaccinations, spreading the fiction that the vaccines contained HIV and were designed to sterilize Muslim girls. Quickly, the poliovirus did what all viruses do when they’re given that kind of running room: it spread, and fast. By 2005, cases consistent with the Nigeria strain were appearing in a 16-nation band that stretched as far away as Indonesia, before the outbreak could finally be contained.

“This is a disease that can’t be controlled,” said WHO spokesman Oliver Rosenbauer at the time, “it has to be eradicated.”

While the current victory in Nigeria was a huge milestone, things remained dicey right to the end—again due to politics—when Boko Haram fighters killed nine polio workers and abducted three others earlier this year. But the vaccine program was already too far along for the attacks to reverse things, and as the July 24 anniversary arrived, victory was at last declared—albeit tentatively.

Nigeria is now officially off the list of endemic countries, but the poliovirus can lurk in sewage and elsewhere, and since there can be up to 200 asymptomatic cases of the disease for every paralytic one, there is no telling how many human virus reservoirs are still at large. Only after two more polio-free years pass will Nigeria be declared officially done with the disease.

That leaves Afghanistan and, most troublingly, Pakistan. Currently, there have been only 33 cases of polio recorded worldwide in 2015—28 in Pakistan and 5 in Afghanistan. At the same point last year, those two countries had already had 107 infections, and the Pakistani strain had turned up in at least six other countries.

Progress has been slowed in Pakistan by often-deadly attacks on polio field workers carried out by local Taliban fighters. Since 2012, however, the government has been providing help, committing its military to protecting the vaccinators and recruiting religious leaders to speak out on the moral imperative of ensuring the health of children.

National pride plays no small role too. India—Pakistan’s mortal rival—has not had a case of polio since 2011 and was declared officially free of the disease last year. That the Indians accomplished this in a country with four times the landmass and seven times the population of Pakistan has been galling to many Pakistanis. The dramatic reduction in new infections in Pakistan from 2014 to 2015 has been a point of national pride.

Protecting children should not, of course, be a matter of international bragging rights. It should just be something human beings do. We’re a species smart enough to have invented a vaccine and brave enough to go delivering it in very dangerous places. The effort to eradicate polio has been a halting thing, and we have too often gotten in our own way. But at last, sometimes despite ourselves, we appear to be on the brink of winning.

TIME global health

Here’s How Much More Money Is Needed to Improve Global Health

Outbreaks like Ebola highlight the gaps in the way money is raised and used for protecting people’s health, a new study finds

In a report published in the journal Lancet, researchers point out large gaps in the money raised and dispatched for public health purposes and the medical needs of countries, particularly in the developing world, to keep their populations healthy.

Despite recurrent outbreaks of pandemic infections such as SARS and, most recently, Ebola, donors have committed less than a third of the estimated $3.4 billion that is needed to maintain a strong pandemic preparedness system, according to the World Bank. Overall, donor countries have spent only half of the $6 billion that the World Health Organization says is needed to maintain global public health.

What’s lacking, the study authors say, is a more focused system for investing in global health that emphasizes programs designed to achieve certain public health functions, such as vaccinating a particular population or corralling antibiotic resistance or the spread of multi-drug resistant tuberculosis. It’s an approach championed by philanthropic organizations such as the Bill & Melinda Gates Foundation, the organization that funded the study. Part of the funding conditions of its programs include specifying outcomes and a timeframe for achieving them.

“For example, countries like China and India would substantially benefit from market shaping to lower drug prices and increased international efforts to control multi-drug resistant tuberculosis,” Dr. Marco Schaferhoff, association director of SEEK Development in Germany and one of the co-authors of the report, said in a statement. “At the same time…donor countries should also ensure that vulnerable and marginalized populations in middle-income countries, such as ethnic minorities who suffer discrimination, refugees, and people who inject drugs, receive sufficient support.”

TIME Disease

South Korea Authorizes Prison Time for MERS Patients Who Break Quarantine

Quarantine tent in Seoul, South Korea
Chung Sung-Jun—2015 Getty Images Visitors wearing masks walk in front of a health advisory sign about the MERS virus at a quarantine tent for people who could be infected with the MERS virus at Seoul National University Hospital on June 2 in Seoul, South Korea.

The country is in the midst of the worst outbreak ever seen outside of Saudi Arabia

South Korea tightened quarantine restrictions on patients at risk of being infected with Middle East Respiratory Syndrome virus, declaring that those who defy orders or lie about their potential exposure are now subject to prison terms.

Health officials announced that violators could face up to two years in prison and a fine of 20 million won, or approximately $18,000. Currently, defying quarantine can result in a fine but not a jail sentence.

The new law, which grants greater authority to public health investigators, does not take effect for another six months. The latest tally for the disease reached 181 confirmed cases and 31 confirmed deaths since the outbreak began last month.

[New York Times]

TIME health

How the Gates Foundation Aims to Cut Childhood Mortality in Half

Filling bellies: Melinda Gates and the Gates Foundation are going after one of the leading killers of babies
J. Countess; Getty Images Filling bellies: Melinda Gates and the Gates Foundation are going after one of the leading killers of babies

Jeffrey Kluger is Editor at Large for TIME.

A new grant will go straight after a leading killer of kids under five: undernutrition

Correction appended, June 3

There are a lot of ways to think about child mortality—most of them not very pretty. You can think of the 6.3 million children every year who never live to see their fifth birthday. You can think of how that breaks down to the loss of 17,260 babies every day, day after day, for 365 days.

But you can also think that those terrible numbers are exactly half of what they were in 1990, meaning that last year, 6.3 million children who would not have seen age five did. Most of that extraordinary progress has been made by controlling, treating or vaccinating against preventable diseases like cholera, measles, pneumonia and malaria. Now, the Bill and Melinda Gates Foundation proposes to slash the child mortality rate in half once more, announcing a plan to invest $776 million over the next six years to advance one of the most primal and important health interventions of all: giving kids enough to eat.

Death by starvation or undernutrition can be hard to track, because while it’s not always the proximate killer, it’s often the accomplice. Expose a well-nourished child and an undernourished child to, say, the measles virus and it’s no mystery which one of them has a better prognosis.

“Estimates are that in about 50% of all of the remaining under-five deaths, nutrition played at least a significant role,” said Melinda Gates in a conversation with TIME.

The Foundation aims to change that in a lot of ways—little of which will involve the old bags-of-rice-offloaded-at-the-airport model. Emergency supplies can fill gaps in times of natural disasters, but they are, as Gates calls them, downstream strategies—sustainable only as long as the supplies keep flowing from generous benefactors. Upstream strategies involve putting systems in place so that generous benefactors are eventually not needed.

Part of the new strategy will involve providing seeds and the know-how for planting and harvesting such bulked-up crops as golden rice, the super banana and the fortified sweet potato. These and other GMO foods have caused all manner of controversy in the developed world, but people like the Gates focus on the increased vitamin A in such crops, which builds skin, teeth, bones and soft tissue and has anti-oxidant properties.

Instruction will also be given in no-till agriculture and drip-irrigation, which conserve both water and soil. Research stations will be opened in targeted areas to increase public awareness of both the existence of the crops and the best ways to raise them. And a special effort will be made to put this knowledge at the disposal of the family member who is likeliest to make the best use of it: the mother.

“Fifty percent of all farmers in Africa are women,” says Gates. “And research shows that every extra dollar a woman gets is 90% likelier to be put back into the family than a dollar a man gets. We want to put women at the center of this.” Expanding wireless access is another key part of the program, allowing farmers—men or women—to have ready access to commodity prices, so they can sell their crops at the top of the market.

Women are central in other ways too. Good nutrition starts before a baby is born, and most health experts believe it is the first 1,000 days—from conception through age two—that make the greatest difference in long-term physical and intellectual development. That means educating young women and adolescent girls about proper diet before they get pregnant, and encouraging breastfeeding after birth.

The Foundation will also be pressing to get government and religious leaders to climb on board—or at least get out of the way. “We need governments to impose the regulations needed to get the most out of nutrition programs,” says Gates. “We can do that by showing them the evidence. Brazil, for example, has gotten its malnutrition rate down by 80%. So we show that data and say, ‘Now it’s up to you to decide.'”

And while Taliban extremists have tried to block polio vaccination efforts in Pakistan, that kind of deadly obstructionism is hardly true of all parts of the Muslim world. “Nigeria has a high Muslim population and they have said ‘We will help you,'” Gates says,—and not just in matters directly related to food. “The Koran allows for family planning and we can get that message out.”

For now, the Foundation’s funds will be concentrated in five critical spots: India, Ethiopia, Nigeria, Bangladesh and Burkina Faso. That money will be supplemented by even more. The Gateses’ grant frees up $180 million in partial matching funds from the U.K.’s Department for International Development. The European Union, meanwhile, has pledged a whopping €3.5 billion by 2020 to battle child malnutrition.

That’s a big number—but it comes from a bloc of 28 nations. The Gates grant comes from a couple with a foundation and a mission. If that mission includes saving 17,260 babies every 24 hours, well, that’s a pretty fair day’s work.

Correction: The original version of this story misstated the amount of money the Bill and Melinda Gates Foundation is investing. It is $776 million.

Read next: Here’s What’s on Bill Gates’ Summer Reading List

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TIME Infectious Disease

Bill Gates Thinks This Is the Deadliest Threat to Humankind

Bill Gates, co-founder of Microsoft and co-chair of the Bill and Melinda Gates Foundation, speaks at a breakfast meeting with the theme "Dialogue: Technology Innovation for a Sustainable Future" during the Boao Forum For Asia Annual Conference 2015 in Qionghai city, south Chinas Hainan province, 29 March 2015.
Cui hao—Imaginechina/AP Bill Gates, co-founder of Microsoft and co-chair of the Bill and Melinda Gates Foundation, speaks at a breakfast meeting with the theme "Dialogue: Technology Innovation for a Sustainable Future" during the Boao Forum for Asia Annual Conference 2015 in Qionghai city, China's Hainan province, on March 29, 2015

He says it could kill tens of millions

In the next 20 years, is it likely that nuclear war, gigantic earthquakes or asteroids could kill 20 million people? Bill Gates doesn’t think so.

But he did tell Vox that such numbers could be felled by a major outbreak of disease — something the 59-year-old billionaire believes has a “well over 50%” chance of happening in his lifetime.

“The Ebola epidemic showed me that we’re not ready for a serious epidemic, an epidemic that would be more infectious and would spread faster than Ebola did. This is the greatest risk of a huge tragedy,” Gates said, claiming that a serious epidemic could kill more than 10 million people a year.

Read more at Vox

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