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Bill Gates
Grand Challenges Annual Meeting
Berlin, Germany
October 16, 2018
AS PREPARED


Thank you, Kedest. And welcome, everyone, to the 14th annual Grand Challenges meeting.

This isn’t our typical Grand challenges event. Tonight, we’re also celebrating the 10th anniversary of the World Health Summit.

And we’re honored that some of the world’s most important leaders in the fight against global poverty and disease are here, too. Director General Tedros of the WHO, Prime Minister Solberg of Norway, and Chancellor Merkel have joined us.

It’s appropriate that we’re holding this year’s meeting in Germany. Grand Challenges is about identifying the most important unsolved problems – and then soliciting the best ideas to solve them. And that is actually a German idea.

When we started the Grand Challenges program 15 years ago, we based it on the work of a German mathematician: David Hilbert.

Hilbert is probably most famous for a speech he gave at a Paris mathematics conference in 1900. There, he encouraged his fellow mathematicians to tackle a list of 23 problems that had never been solved before.

Hilbert was not optimistic that all of these problems would be solved in short order. For instance, his list of questions included proving the Reimann hypothesis, which has to do with the distribution of prime numbers. Hilbert had once told his students, "If I were to awaken after having slept for 1,000 years, my first question would be: Has the Riemann hypothesis been proven?"

It’s worth asking: How has his prediction panned out?

Well, Hilbert has only been dead for 75 years – not 1,000 – but it looks like his instincts were right: Although many have attempted, there is still no verified proof of the Reimann hypothesis.

Then again, 20 of Hilbert’s other 22 problems have been solved or partially solved. More importantly, the process of solving them has led to new fields that Hilbert did not imagine in 1900, like quantum mechanics.

This is why we based Grand Challenges on Hilbert’s questions – and why I am so passionate about the broader process of innovation. Because we do not always succeed. But when we do, we can exceed even our best-case scenarios.

This is especially true in the fight against global poverty and disease, and tonight, I would like to share with you 3 examples… 3 stories about our recent progress.

The first story is about the antibiotic, azithromycin. A team of researchers at a Croatian pharmaceutical company discovered it back in 1980, and initially it proved effective at treating trachoma – the leading cause of infectious blindness.

I am not sure what that team of Croatian scientists was hoping for when they began their research. But my guess is that they would’ve been very happy with a drug that could save millions of people’s sight.

But that’s not the end of the story. Because over the years, clinicians using azithromycin in the field developed a hunch that it might have broader benefits than just treating trachoma.

From 2015 to 2017, we tested this hunch. Health workers in Niger, Malawi, and Tanzania distributed one azithromycin or placebo to roughly 200,000 children in high-mortality areas.

The children didn’t have trachoma. We just wanted to see if it would help them stay healthy, and it did. Azithromycin reduced deaths by an average of 13% in children under five years, and by 25% in infants between 1 and 5 months old.

Child mortality has been cut in half since 1990. Still, more than 5 million children under 5 died last year. Azithromycin – a 40-year-old drug – could help us cut that number even more.

Now, we are thinking about how best to deliver this drug in poor countries. We’re testing to see if azithromycin can save newborns’ lives if we give it to them shortly after they’re born—or to their mothers during pregnancy. In fact, the WHO is formulating new guidelines for the use of azithromycin right now, so this drug could be saving more lives by next year.

It goes to show that innovation doesn’t always mean inventing something new. Sometimes old drugs still have new tricks. And if we keep the needs of the poorest top-of-mind in our work, we can help many more people than initially expected.

Mosquito-borne illness is another area where we can beat the best-case scenario.

For example, our goal is to eliminate malaria by the year 2040, and I know that is an ambitious goal. Especially since we’ve seen an uptick in the number of malaria cases in some places in sub-Saharan Africa.

But the goal could be attainable because of technologies like "gene drive." Essentially, scientists could introduce a gene into a mosquito population that would either suppress the population—or prevent it from spreading malaria.

For decades, it was difficult to test this idea. But with the discovery of CRISPR, the research became a lot easier. And just last month, a team from the research consortium, Target Malaria, announced that they’d completed studies where mosquito populations were fully suppressed.

To be clear: The test was only in a series of laboratory cages filled with 600 mosquitos each. But it’s a promising start.

Then there’s dengue fever.

Dengue is spread by a species of mosquito called Aedes aegypti. By the early 2000s, the scientific community had been trying and failing at a vaccine for years, which when a scientist named Scott O’Neill had an idea: What if instead of vaccinating the people, we treated the Aedes aegypti mosquito?

Most insects contain bacteria called Wolbachia. But the Aedes aegypti does not. And O’Neill and his team believed that by introducing Wolbachia to the Aedes, they would shorten the mosquito’s lifespan, killing the mosquito before it had time to transmit dengue.

We decided to fund the project as one of our initial Grand Challenges grantees, and it didn’t work as planned at first. The Wolbachia wasn’t killing the mosquitos or shortening their lifespan. But it was doing something just as good: It made it impossible for Aedes to transmit dengue.

Today, Scott O’Neill’s World Malaria Program is conducting studies in cities around the globe including Yogyakarta, Indonesia, where exactly half of the city has Wolbachia mosquitos and the other half doesn’t.

We won’t have the official results until 2019 when the study concludes. But we do have some interesting anecdotal results: In Yogyakarta, locals say that home prices are going up in the Wolbachia half of the city – and so are the size of day care classes. Mothers from the control half of Yogyakarta want to their young children where the Wolbachia are.

There are even indications that Wolbachia might prevent the Aedes from transmitting other diseases, like chikungunya and Zika.

I have one final story. It’s about vaccines, and I’ll begin it with what’s been among the hardest vaccines to develop – one for tuberculosis.

There is one licensed TB vaccine, BCG, but it is almost 100 years old and doesn’t provide substantial protection against pulmonary TB in adults. Which is why the disease continues to devastate working-age populations, especially in South Asia and Africa.

Last month, however, there may have been a breakthrough: About a quarter of the world population has the bacteria that causes TB but doesn’t yet have the disease itself. And it was reported that a new TB vaccine, M72, showed significant efficacy in preventing TB among people already infected with M. tuberculosis.

What’s most exciting about the TB vaccine is that it is not a singular innovation: It’s part of a wider trend in which many of you are not only discovering new vaccines—you’re discovering entirely new ways to make vaccines.

For example, for the past 5 years, we’ve been working with CureVac AG here in Germany. CureVac is a biotech company, and they’re developing platforms that use the body’s own machinery to produce vaccines from administered mRNA – the molecules used to turn genetic information into proteins.

The implications of mRNA vaccines are enormous: They could be produced cheaply and quickly – maybe even quickly enough to respond to a new global pandemic, something like Ebola.

All of this has only been a theory, however, until recently. Now, CureVac has successfully introduced mRNA vaccines in small and large animals. And last year, while testing mRNA vaccines for flu and rabies, they found them to be much more durable than the standard versions.

Robert Koch, the German biologist who discovered the M. tuberculosis bacterium here in Berlin back in the 1880s, once said that "If my efforts have led to greater success than usual, [it’s because] I have strayed onto paths where the gold was still lying by the wayside."

Between the potential for a TB vaccine and new advances with the mRNA platform, it’s clear that there’s a lot more gold out there in the pursuit of new vaccine technology. And we’re not only discovering new tools, we’re also able to give them to people in need.

For example, if a new TB vaccine were to be approved, we could deliver it via a global network of health care workers that already immunizes 100 million children a year. And that’s because leaders like Chancellor Merkel and Prime Minister Solberg give generously to GAVI, the world’s vaccine fund.

Or think about using mRNA vaccines to combat outbreaks like Ebola. Those vaccines could be paired with other response efforts developed by the Coalition for Epidemic Preparedness Innovations. Which nations like Norway and Germany also support.

This brings me to my final point: It’s good we have both leaders in government and leaders in science in the room tonight. Because we need each other.

To the policymakers in the room, the tools we have today aren’t enough to solve the challenges we’re facing. Whether it’s responding to pandemics, or reducing child mortality, or eradicating malaria, we need innovations like the ones I’ve described.

But to the scientists here, those innovations only get to people in need because governments support the first and last miles of the innovative process. They fund research and help deliver the outcomes.

Director General Tedros is going to speak more about this. He’ll talk about the WHO’s SDG3 Action Plan; it describes how we can accelerate progress if governments align behind – and invest in – certain areas of innovation.

And this work is more crucial than ever. Because fewer and fewer nations are willing to do it. Many countries are retreating from the world.

We need more leaders like Prime Minister Solberg and Chancellor Merkel to take the opposite course.

In fact, we need countries like Germany to increase their role. It’s one of the reasons that today we announced our foundation is opening a new European office in Berlin.

I’ve told you about some exciting scientific research tonight. But it’s still just research.

Whether it remains that way – or leaves the lab and helps people out in the world – is a function of how many leaders step up to support this science. I am hopeful that they will.

 

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