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How Innovation Can Build the Future Our Grandchildren Deserve

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Gates, co-founder of Microsoft, is co-chair of the Bill & Melinda Gates Foundation and the founder of Breakthrough Energy.

I’ve been saying for years that the world is getting better. I’ll point out that, for example, the number of young children who die before their fifth birthday has fallen by more than half in just two decades—from 10 million in 2000 to just over 4 million today.

But current events are making it harder to argue that the future will be better than the past. Russia’s war on Ukraine is inflicting terrible suffering in Eastern Europe and driving up food and energy prices around the world. The COVID-19 pandemic caused millions of deaths and severely hampered efforts to immunize children. Economic growth is slowing. And climate change is leading to more frequent extreme weather.

These setbacks are causing the most pain for people who were already the worst off. It would compound the tragedy if nations stopped doing the things that have worked for the past two decades—including being generous with foreign aid. The world should continue to do more to help the poorest.

The good news is that this is eminently achievable. We can continue to reduce health inequity while dealing with war, the economy, the pandemic, and climate change—thanks in part to innovations in global health that will allow the world’s efforts to have more impact than ever.

Some of these innovations are already being deployed, like a new polio vaccine that will move us closer to eradication despite recent setbacks. Others are being tested now with the potential to be used more widely soon, like AI-powered ultrasounds that could help save mothers and their babies.

Although the number of children who die before age 5 has gone down dramatically, the number of babies of who die in the first 30 days of life—what’s known as the neonatal period—is not dropping nearly as fast. Almost 1.9 million newborns died in 2019, only a third fewer than in 2000.

The causes of neonatal deaths are complicated. To make a dent in them, health workers need to deal with underlying causes as early in the child’s life as possible, or even before they’re born. The first step is to identify women with the greatest risk of complications during pregnancy. In rich countries like the United States, we do this with frequent checkups, lab tests, and an ultrasound.

But in low-income settings, ultrasound machines simply aren’t practical. They’re bulky, expensive, and require special training to use. That’s why the foundation and several partners are funding work to vastly simplify the process. Instead of wheeling in a big machine on a cart, you just plug a probe into a mobile phone or tablet. You swipe it across the mom’s belly a few times, and then up and down. Software uses artificial intelligence to read the images and provide all the information that a trained human would provide.

This super-promising approach is being tested in Kenya and South Africa to see whether using it at scale makes a measurable difference for moms and babies. If it does, we’ll bring in more partners to reduce the cost so that more countries can afford it.

Some of the innovations I’m most excited about are a lot further away, but they have the potential to save and improve millions of lives.

Based on recent research, I think there’s a good chance a cure for HIV will be available in 10 to 15 years. The key is breakthroughs in gene therapy, which involves making edits to small portions of a person’s genetic makeup. These edited genes can’t be passed on to the person’s children, but they can fix genetic mutations that cause the patient debilitating and deadly medical problems.

Scientists are working on various ways to accomplish this. (One involves modifying the surface of the cells that HIV likes to invade, making it much harder for the virus to get inside them.) There are still years of work ahead before any of these approaches are proven safe and effective, and the earliest versions might be short-lived and require additional doses to keep the HIV from coming back.

But the potential impact is enormous. Today, roughly 38 million people around the world are living with HIV, and another 1.5 million become newly infected each year. To survive, they have to take antiretroviral drugs every day for the rest of their lives. An ideal HIV cure will free all of them from taking these drugs and save the world millions of dollars a year in treatment costs. It will also mean that millions of people never have to worry about getting HIV in the future.

While there is a lot of bad news these days, I’m inspired by the breakthroughs amazing scientists around the world are making every day—whether they are a lifesaving new use for CRISPR or a groundbreaking new way to produce clean energy. Each one represents a new opportunity to help people, but it’s important to remember that none of these breakthroughs happened overnight. If we want to make things better for the next generation, we need to invest in a better future today.

The opportunities to reduce inequity, even at this tumultuous moment, are out there. Success is a long-term prospect, and it starts with actions we take now. 2023 is the year we should make the most of these opportunities.

This essay is adapted from Gates’ The Year Ahead 2023

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