Innovation & Inequity

Last year, we feared the worst when it came to the Global Goals. But even amid the devastation of the COVID-19 pandemic, we’ve seen that hope can grow from seeds planted years earlier. Here’s what we’ve learned.

2021 Goalkeepers Report, photos: Gates Archive and Getty Images.

by Bill Gates and Melinda French Gates

Co-Chairs, Bill & Melinda Gates Foundation

A year ago, we sat down to write an unusual Goalkeepers Report. After years of steady progress on the United Nations’ Sustainable Development Goals (SDGs), the first wave of the COVID-19 pandemic was devastating families, health systems, and economies. We feared it was triggering an unprecedented reversal of progress across nearly every measure of health and prosperity that we track each year in this report.

Indeed, it has been an unprecedented year: Millions of people around the world have died from COVID-19. Millions more have felt the shocks of a global economy in crisis. And still the pandemic rages, with ever more contagious and severe variants spreading around the globe.

 

In so many ways, the pandemic has tested our optimism. But it hasn’t destroyed it.

 

Under the most difficult circumstances imaginable, we’ve witnessed breathtaking innovation. We’ve seen how quickly we can change our behavior, as individuals and as societies, when circumstances require it.

And today, we can also report that people in every part of the world have been stepping up to protect the development progress we’ve made over decades—when it comes to the SDGs, at least, the impact of the ongoing COVID-19 pandemic could have been far worse.

 

It has been a year that has reinforced our belief that progress is possible but not inevitable. The effort we put in matters a great deal. And, as impatient optimists, we believe we can begin to learn from the successes and failures of the pandemic so far. If we can expand upon the best of what we’ve seen these past 18 months, we can finally put the pandemic behind us and once again accelerate progress in addressing fundamental issues like health, hunger, and climate change.

Melinda French Gates
Bill Gates

The Data Tells a Surprising Story

Over the past year, it has been impossible to ignore stark disparities not only in who has gotten sick and who has died—but also in who had to go to work, who could work from home, and who lost their jobs entirely. Health inequities are as old as the health systems themselves, but it took a global pandemic to forcefully remind the world of their consequences.

Millions More in Extreme Poverty

For many, the economic impacts of the pandemic continue to be severe and enduring. We know we may seem like unlikely messengers on this topic—we’re two of the most fortunate people on the planet. And the pandemic has made that even more clear. People like us have weathered the pandemic in good shape, while those who are most vulnerable have been hit the hardest and will likely be the slowest to recover. An additional 31 million people around the world have been pushed into extreme poverty as a result of COVID-19. Although men are 70% more likely to die from COVID-19, women continue to be disproportionately affected by the economic and social impacts of the pandemic: This year, women's employment globally is expected to remain 13 million jobs below the 2019 level—while men's employment is largely expected to recover to pre-pandemic rates.

Although variants threaten to undermine the progress we’ve made, some economies are beginning to recover, bringing with them business reopenings and job creation. But recovery is uneven between—and even within—countries. By next year, for example, 90% of advanced economies are expected to regain pre-pandemic per capita income levels, while only a third of low- and middle-income economies are expected to do the same. Poverty reduction efforts are stagnating—and that means nearly 700 million people, the vast majority in low- and middle-income countries, are projected to remain mired in extreme poverty in 2030.

Growing Gaps in Education

We’re seeing a similar story when it comes to education. Before the pandemic, nine out of 10 children in low-income countries were already unable to read and understand a basic text, compared to one in 10 children in high-income countries.

Early evidence suggests that learning losses will be greatest among marginalized groups. Growing educational disparities were found in wealthy countries, too. In the United States, for example, learning loss among Black and Latino third grade students was, on average, double that of white and Asian American students. And learning loss among third graders from high-poverty schools was triple those of their peers in low-poverty schools.

More Children Missing Vaccines

Meanwhile, global routine childhood vaccination rates fell to levels last seen in 2005. Between the start of the pandemic and when health services began to recover in the second half of 2020, more than 30 million children around the world missed their vaccinations—that’s 10 million more because of the pandemic. It’s possible that many of these children will never catch up on doses.

But here, the data surprised us: A year ago, we had reported that the Institute for Health Metrics and Evaluation was estimating that vaccine coverage would drop 14 percentage points globally in 2020, which would have amounted to 25 years of progress down the drain. But based on more recent data, it looks like the actual drop in vaccine coverage—devastating though it was—was only half that.

Legend:
Sub-Saharan Africa
South Asia
Latin America and the Caribbean
North Africa and Middle East

People Stepping Up

As we continued to sift through the data, it became evident that this was not a fluke: On many key development indicators, the world stepped up over the past year to avert some of the worst-case scenarios.

 

Take malaria, for example, which has long been one of the world’s most deeply inequitable diseases: 90% of malaria cases are found in Africa. Last year, the World Health Organization forecasted severe disruptions to essential malaria prevention efforts that could have set progress back 10 years—and result in an additional 200,000 deaths from a preventable disease. That projection spurred many countries to action to ensure that bed nets were distributed and testing and antimalarial drugs remained available. Benin, where malaria is the leading cause of death, even found a way to innovate in the midst of the pandemic: They created a new, digitized distribution system for insecticide-treated bed nets, getting 7.6 million nets into homes across the country in just 20 days.

Agent Jean Kinhouande distributes mosquito nets in the Agla district of Cotonou, Benin, to fight malaria despite the COVID-19 pandemic disruption. (Photo by Yanick Folly/AFP via Getty Images, April 28, 2020)

Cotonou, Benin

Photo courtesy of Yanick Folly/AFP via Getty Images

They deserve the world’s gratitude.

Of course, the full extent of the pandemic’s impact on the SDGs will take years to fully understand, as more and better data becomes available. And this data doesn’t diminish the very real suffering the pandemic has caused for people everywhere—far from it. But the fact that we can point to positive signs amid a once-in-a-generation global pandemic is extraordinary. With one hand tied behind their backs, countless individuals, organizations, and countries went above and beyond to innovate, adapt, and build resilient systems, and for that, they deserve the world’s gratitude.

What the So-Called Miracle of Vaccines Shows Us

New vaccines usually take about 10 to 15 years to make. So, the development of multiple high-quality COVID-19 vaccines in less than a year is unprecedented.

And it’s easy to see why that might seem like a miracle. But in fact, the COVID-19 vaccines are the result of decades of careful investment, policies, and partnerships that established the infrastructure, talent, and enabling ecosystem needed to deploy them so quickly.

 

We have scientists around the world to thank for their years of foundational research. One researcher, Hungary’s Dr. Katalin Karikó, dedicated her career to studying messenger RNA, also known as mRNA. For years, her unorthodox ideas failed to gain broad support and funding, and many dismissed the idea that mRNA could be used to make vaccines and therapeutics. But Dr. Karikó persevered. Her story is emblematic of the many scientists whose discoveries—often years in the making—have made it possible for two highly effective mRNA vaccines to be developed in less than one year.

 

It’s a gift that will keep on giving: There are already mRNA vaccine candidates in the development pipeline that could finally tackle some of the world’s deadliest diseases, from malaria to cancer.

 

Of course, mRNA vaccines aren’t the only R&D success story to come out of this approach.

The long-term promise of genomic sequencing

By now, the whole world is keenly aware that SARS-CoV-2, the virus that causes COVID-19, has mutated into increasingly infectious and deadly variants, like delta, as it spreads around the world. Thanks to genomic sequencing—identifying the unique genetic makeup of a virus—scientists have been able to identify and track emerging variants.

 

Historically, the majority of the genomic sequencing in the world has taken place in the United States and Europe. Countries without sequencing technology would send viral samples to labs in places like New York and London for genetic analysis—and they’d only get results months later.

 

But for the past four years, organizations have been investing in building a genomic surveillance network in Africa, so countries on the continent could sequence viruses like Ebola and yellow fever. The Africa CDC established the Africa Pathogen Genomics Initiative, and when the pandemic hit, the nascent network turned its attention to SARS-CoV-2. The only reason the world knew that the more infectious and deadly beta variant had emerged in South Africa was because the country had invested heavily in R&D—in this case, pairing genomic sequencing capabilities with clinical trials and immunology studies. South Africa’s own Dr. Penny Moore was one of the first scientists to discover that a coronavirus variant identified in South Africa could circumvent the immune system.

 

With this information, public health officials around the world could plan accordingly. And South Africa, which has also invested deeply in infrastructure to rapidly and effectively conduct clinical trials, could quickly adjust its vaccine trials. They began working to determine whether COVID-19 vaccines provided sufficient protection against the new variant that would soon spread everywhere.

It’s insufficient for rich countries to be the only ones with the equipment and resources to sequence viruses.

It seems obvious that in a globalized world, where people and goods move constantly across borders, it’s insufficient for rich countries to be the only ones with the equipment and resources to sequence viruses. But it took a pandemic to reinforce how important it is to support the ability of low- and middle-income countries to collect and analyze their own data—because it benefits everyone.

 

And what’s particularly exciting about Africa’s genomic sequencing network is that the technology works for any pathogen: If the continent is able to keep building the network, it will soon be doing its own disease tracking for long-standing viruses like flu, measles, and polio.

 

Scientific innovation, even at a record-breaking pace, isn’t enough on its own. The COVID-19 vaccines are an amazing feat of R&D, but they are most effective when everyone has access to them. The inequities of the past year remind us that this is far easier said than done.

 

It’s up to people—from the halls of power to grassroots organizations and neighborhood groups—to step up to fill the gaps. And this year, it was these dynamic human interventions, when met with previous investments in systems, in communities, and in people, that allowed the world to avoid some of those initial, worst-case predictions.

Investing in Systems

As we write this, more than 80% of all COVID-19 vaccines have been administered in high- and upper-middle-income countries. Some have secured two to three times the number of doses needed to cover their populations, in case boosters are needed for increasingly infectious variants. Meanwhile, less than 1% of doses have been administered in low-income countries. These inequities are a profound moral outrage—and raise the very real risk that high-income countries and communities will begin to treat COVID-19 as another epidemic of poverty: Not our problem.

42M 39.5M

The infrastructure needed to quickly manufacture an additional 15 billion vaccine doses cannot be set up overnight, or even in a year. But India provides an example of what happens when that infrastructure is built up over the long term.

 

India has been investing in its health care manufacturing infrastructure for decades—since the country’s independence. The Indian government helped Pune, a city near Mumbai, become a major global manufacturing hub by investing in R&D capacity and local infrastructure, like electricity, water, and transportation. They worked with the World Health Organization to build a regulatory system for vaccines that upheld the strictest international standards for quality, safety, and efficacy. And they partnered with vaccine manufacturers in Pune and other hubs like Hyderabad and our foundation to develop, produce, and export vaccines that tackle the deadliest childhood illnesses, from meningitis to pneumonia to diarrheal diseases.

 

Of course, simply having manufacturing capacity wasn’t sufficient to negate the crisis of COVID-19 in India—it’s just one piece of the puzzle—but it is a remarkable feat of progress that today more than 60% of all vaccines sold globally are manufactured on the subcontinent.

 

We’ve also seen that countries that have strong government investment in health infrastructure are far better able to proactively track, and in many cases, contain the spread of COVID-19. Long-term investments in eradicating wild polio in lower-income countries have helped countries like Nigeria and Pakistan build one of the largest operational workforces in modern global health. Investing in polio eradication created infrastructure for outbreak response and vaccine administration—which made a critical difference in disease outbreaks from Ebola to COVID-19.

 

That’s why long-term investments in health systems are so worthwhile: They are the foundation for emergency disease response. We might not have known which specific pathogen would lead to a once-in-a-generation global pandemic, but the tools to end the pandemic are largely the same as for polio or malaria or other infectious diseases: widespread testing and, when possible, fast and effective treatment and lifesaving immunization.

Investing in Communities

Some of the most effective interventions we’ve been tracking have happened at a hyperlocal level, headed by leaders who have worked long and hard to earn the trust of their communities—something that cannot be built overnight or in the midst of a crisis.

Women’s “self-help groups” are common across India as well as other parts of South and South-East Asia. For years, the Indian government and global partners have been investing in these small collectives of women who pool money and work to improve health, education, and other services in their villages.

 

When COVID-19 arrived in Bihar, India, home to more than 100 million people, one local self-help group established trust with their neighbors by delivering meals and home-based health care to those who had fallen ill from COVID-19. When vaccines were ready for distribution in their community, these women became a source of information and guidance for those same neighbors who had concerns about vaccine safety. The Bihar government took notice of the work being done at the community level and declared March 8—International Women’s Day—a day to vaccinate women across the state. Nearly 175,000 women took the first dose of the vaccine that week. Building on that success, the government of Bihar is replicating the program, guided by the women of the self-help group.

Roona and Veena Devi (L–R), members of a self-help group organized by Jeevika, at work during an SHG meeting in Gurmia, Bihar, India. (August 28, 2021)

Vaishali, Bihar, India

Gates Archive

And in Senegal, community-based outreach has been key to delivering other vaccines, too.

 

Senegal has been one of the success stories of routine immunization coverage: Before the pandemic, children were immunized against diphtheria, tetanus, and pertussis at similar rates as children in the United States and other high-income countries. But when COVID-19 arrived, fear of infection and misinformation reduced the demand for these vaccines dramatically.

 

Social distancing and school closures forced health workers to adapt their outreach strategies. Senegal trained health workers on how to resume immunization safely, while letting local officials adapt outreach strategies to meet local needs. Clinic staff now use immunization records to identify children who are missing vaccinations and send text message reminders to their families. And they’ve made it easier for those families to respond: The country’s extensive and trusted cadre of community health workers are going home to home to deliver vaccines, and reopened clinics are providing greater flexibility for the location and timing for scheduling catch-up doses.

 

In both these examples, solutions for the community came from within. The communities themselves led the way in developing innovative strategies to slow the spread of COVID-19 in ways that worked for their particular localities, and foundations and government partners lent their support. These investments in community building will be worth nurturing long after the pandemic is behind us.

2021 Goalkeepers Report, photos: Gates Archive and Getty Images.

Investing in Women and Girls

We’re seeing new innovations when it comes to how governments address crises, too. Of course, major policies often take years, decades even, to take root and make an impact. But once enacted and implemented, those policies can have far-reaching and long-lasting effects. In many ways, effective policymaking is the ultimate long-term investment.

Consider the pandemic’s economic gender divide: Even though each country has its own unique story to tell, we’re seeing that in high- and low-income countries alike, women have been harder hit than men by the global recession that was triggered by the pandemic. But—importantly—data also show that the negative effect on women has been smaller in countries that had gender-intentional policies in place prior to the pandemic.

 

That’s why we’re so encouraged to see governments around the world putting women at the center of their economic recovery planning and policymaking.

Pakistan expanded its Ehsaas Emergency Cash program to get money to poor households, with women making up two-thirds of the program’s intended recipients. Ehsaas provided emergency cash assistance during the pandemic to nearly 15 million low-income households—42% of the country’s population. And the effects will have a lasting impact: more than 10 million women being brought into the formal financial system for the first time.

 

Argentina recently published its first budget with a gender perspective, directing more than 15% of public spending toward programs that target gender inequality. With guidance from a newly appointed director of economy, equality, and gender in the Ministry of Economy, they’ve adopted policies that support women and families, such as establishing 300 new public childcare centers in the country’s poorest neighborhoods.

 

And in the United States, the Hawaiian state government is putting women and girls—as well as Native Hawaiians, immigrants, transgender and nonbinary people, and people living in poverty—at the center of its economic recovery efforts. The first gender-oriented economic recovery plan in the United States includes proven policies that support women’s long-term economic empowerment, such as paid sick days and family leave, universal childcare, and raising the hourly minimum wage for single mothers.

 

We’re eager to see the long-term outcomes from these innovative approaches toward women’s economic empowerment. But even in this early phase, these are encouraging new models of policymaking. These policies won’t just make a difference in the short term; they’ll help ensure greater economic stability the next time a crisis comes around.

Even Further, Even Faster

If the past year has shown us anything, it’s this: Simply addressing the crisis at hand means we’ll always be playing catch-up. To make future “miracles” possible, we need to think in generations, not in news cycles.

Long-term investments are rarely the exciting, easy, or politically popular thing to do. But those who have made them have seen meaningful returns amid a crisis of historic proportions. So many of the groundbreaking innovations of the past year have one thing in common: They grew out of seeds that were planted years—or even decades—earlier.

 

So, it’s clearer than ever that we need more governments, multilateral organizations, and foundations like ours to make forward-thinking investments, knowing that the returns might be many years down the road. We must work with others to support talented researchers around the globe to identify new tools and technologies that could be building blocks for solving a multitude of challenges. And we must strengthen collaboration across countries and sectors to work together toward common goals.

 

But it’s not enough for high-income countries to simply keep investing money and resources internally and hoping their game-changing innovations make their way to the rest of the world. We also need to invest in R&D, infrastructure, and innovation of all kinds closer to the people who most stand to benefit.

New sources of innovation

We’ve seen that COVID-19 vaccine access is strongly correlated with the locations where there is vaccine R&D and manufacturing capability. Latin America, Asia, and Africa are being hit particularly hard by the delta variant right now because so much of their population remains unvaccinated. Africa, in particular, has had difficulty getting access to the doses they need. The continent—home to 17% of the world’s population—has less than 1% of the world’s vaccine manufacturing capabilities. If African leaders, with donor support, invest in and build a sustainable regional vaccine development and manufacturing ecosystem, the continent would be far less likely to be last in line in a future pandemic.

Workers develop reagent kits for COVID-19 at the Beijing Applied Biological Technologies (XABT) R&D laboratory in China. (Photo courtesy of Nicolas Asfouri/AFP via Getty Images May 14, 2020)

Beijing, China

Photo courtesy of Nicolas Asfouri/AFP via Getty Images

 

That’s why we’re supporting the Africa CDC and African Union’s vision to do just that by 2040. It’s not only Africa that would benefit from improved health security and pandemic preparedness; the entire world would benefit from new sources of R&D and scientific innovation.

 

Africa is committed to establishing mRNA manufacturing on the continent, and already, mRNA companies are stepping up to make that a reality. This will allow Africa to create vaccines not just for COVID-19, but potentially also for malaria, tuberculosis, and HIV—diseases that disproportionately affect the most vulnerable.

 

Our call to invest closer to the source is a reflection of our belief in the ability of people all over the world to innovate and solve tough problems. The next big idea or lifesaving breakthrough can be sparked anywhere in the world, at any time. Whether the world will benefit is up to all of us.

Responding to crises starts years before they happen.

It’s not difficult to imagine a world in which Dr. Karikó’s revolutionary ideas about mRNA never got the funding they needed. Or a world in which Africa didn’t have its own genomic sequencing capacity—and the beta variant couldn’t get sequenced in time to act quickly.

 

The pandemic has taught the world an important lesson: Responding to crises starts years before they happen. And if we want to be better, faster, and more equitable in our approach to realizing the Global Goals by 2030, we need to start laying the foundation. Now.

Soni Sharma (in blue), community mobilizer and a “didi” or member of a self-help group organized by Jeevika, records cash deposits during an SHG meeting in Gurmia, Bihar, India. (August 28, 2021)

The Call to Adapt: Innovators for Impact

Just as countries, communities, and organizations have been innovating during COVID, millions of individuals around the world have shown us that each of us—all of us—can also make a mark. These are three such thinkers and makers. They help birth ideas, designs, and babies. They are doers, driven by passion, knowledge, and the unstoppable will to solve problems, and are undeterred by challenging times. When COVID-19 battered the world, it only fortified their spirit. With renewed resilience and determination, they shifted what they did and how they worked. For them, the pandemic became a call to adapt. And to do better. Introducing you to them is just the beginning. We will continue looking to tell the stories of the many more who are blazing trails for a better world.

Melinda French Gates and Strive Masiyiwa

Innovating for Vaccines: Strive Masiyiwa

In May 2020, when the world was scrambling for PPE, testing kits, and ventilators, Zimbabwean mobile telecommunications mogul Strive Masiyiwa accepted a gargantuan challenge. Newly appointed as one of the African Union’s special envoys for COVID response, he embarked on a high-speed chase to help get Africa’s 1.3 billion residents much-needed medical supplies.

 

“The global supply was so limited, and it became a battle. Africa was edged out,” he said at the time. Reporting to seven African presidents who, along with Africa’s CDC, made up the continent’s joint COVID-19 Task Force, the challenge was clear: “My job is to fix the problem in front of me. How do I ensure those critically required supplies are moving?” he says.

 

Strive has made a career of trying to fix the problems in front of him. In 1991, the young entrepreneur was asked by a multinational corporation to help bring satellite phones to Africa. If he raised US$40 million, he’d get 5% of the company and a cut of each phone eventually sold on the continent. But after two years of trying, he did not succeed. Discouraged, Strive went back to his construction business, until the lessons coalesced. Using a Global System for Mobiles (also known as GSM and 3G) seemed like a big opportunity to bring phones to the continent himself. “Suddenly, all the things I had learned … became a massive windfall. It was like I had advanced 25 years as an entrepreneur!” he says.

Strive Maisiwa, founder and executive chairman of the international technology group Econet Global

Strive Masiyiwa, New York City, New York

Fast-forward to COVID-19. Just 28 days after his appointment, Strive assembled a technical team to develop and launch the African Medical Supplies Platform (AMSP), a user-friendly online marketplace for Africa’s 55 governments to access COVID-related medical supplies, streamline logistics, and consolidate buying power for things like LumiraDx test kits and treatments like dexamethasone. Strive and his team also created a pipeline for high-tech ventilators to be manufactured in South Africa, reducing the cost tenfold. And later, when COVAX vaccine deliveries to the continent were delayed, Strive not only worked to secure contracts independently through the African Vaccine Acquisition Task Team (AVATT), but also helped ensure that vaccine manufacturing would take place in Africa. The World Bank and African Union estimate that by January 2022, African manufacturers will have participated in the production of up to 400 million doses for local distribution.

 

A fierce critic of highly resourced nations “pushing their way to the front of the queue to secure production assets,” Strive rejects vaccine nationalism, a stance that has—in many ways—defined his work. “We didn’t ask anyone to give us anything for free,” he insists. “Equitable access meant buying vaccines the same day and time they became available.”

 

Largely pausing his day job during the pandemic, Strive has spent the last year negotiating to help reduce vaccine inequities between rich nations and African ones and has become part of the brain, engine, and heart of Africa’s massive homegrown COVID-19 response. “When we talk about philanthropy, we often talk about money. But this is a once-in-a-lifetime crisis, and the scale of it, both in terms of human cost and human life, as well as economic cost, is pretty profound. You just have to drop what you are doing and tackle it,” he says.

Midwife Efe Osaren tends to a mother during a postpartum visit at the Luna Tierra Birth Center in El Paso, Texas, USA.

Innovating for Birth: Efe Osaren

Efe had just arrived at the hospital when everything changed. Minutes before, when New York City announced its COVID-19 lockdown, she was barreling underground in the subway, mentally reviewing her client’s case: older woman, bed rest, likely preterm C-section, baby that would be delivered straight to the NICU. For first-time mothers, especially those in high-risk pregnancies, birth can be a traumatic experience. For Efe, her job as a doula meant holding their hand through the unchartered journey, ensuring that stress didn’t harm mom and baby alike. Except that on this most anticipated of March dates, an invisible virus barricaded her from the delivery room.

 

Efe Osaren was 15 when she became enthralled by a unique ritual in which her newborn niece was stretched and massaged with palm oil and hot rags. It was a traditional Yoruba bath, and her mom told Efe she’d been bathed that way too, so she’d grow up with strong bones. The bath didn’t make Efe unbreakable, but it did mold her. The Nigerian American student living in Texas knew then she wanted to use tradition and science to help babies come into the world in health. Especially babies born to women of color.

 

In the United States, new Black moms die at higher rates than white ones—irrespective of age, education, rural or urban residence, or socioeconomic status. Black mothers are three times more likely to die in childbirth than white ones. “It makes me feel rageful for my clients,” says Efe. It’s why she also works as a reproductive birth justice advocate. “Pregnancy requires you to feel safe. When you don’t have comfort, you have fear…that can lead to medical emergencies.”

 

Back in a NYC hospital, she encountered her own worst fear—she would not be able to be there with her client. With no time to lose, she summoned her client’s partner and gave him a crash course in the lobby: how to help mom breathe, how to keep her calm with eye contact, how to press on her hips and back, how to instill confidence in her, how to ensure that if she’s wheeled into the OR, she will be safe.

The flash training became the blueprint for Efe’s pivot during COVID. She began teaching virtual birthing classes, empowering her clients through knowledge, and even helping them get tripods and Bluetooth speakers for their phones so they could video chat during labor.

 

An advocate for women of color her whole career, Efe now equips them to do the job themselves. It is not an easy task, because she has become bodyguard, concierge, therapist, and mediator. But she knows her work is important.

 

Note: While research shows that specific interventions can improve the birth experience for moms, more research and funding are needed to identify interventions that reduce racial inequity in maternal outcomes. Accordingly, obstetric quality improvement programs that represent current best practices should be expanded and standardized.

Portrait of midwife Efe Osaren in El Paso, Texas, USA

Efe Osaren, El Paso, Texas

Kuldeep Bandhu Aryal poses for a photo at the BRAC Kuchubunia Production Center in Cox’s Bazar, Bangladesh. (August 29, 2021)

Innovating for PPE: Kuldeep Aryal

On April 25, 2015, Kuldeep Aryal was in his room studying for his college civil engineering exams when a massive earthquake ripped Nepal open. After spending interminable minutes hiding under his home’s structural beams and clinging onto life with nothing but a prayer, Kuldeep went outside and found his neighbor’s home on the ground. It was one of 700,000 houses that had crumbled in the quake.

 

As he began lifting bricks and tiles, a question arose from under the rubble. “How much do I want my engagement with the world to have impact?” he asked himself. And a humanitarian was born. “I never looked back.” What he did not know then was how his work in Nepal’s response and recovery effort would end up informing how he’s done everything since.

 

When COVID-19 hit South Asia, Kuldeep was living in Dhaka. Like all other nations on the planet, Bangladesh was also struggling to source PPE, to create systems for contact tracing, and to get clarity about what it meant to be locked down at home indefinitely. But hope, it turns out, was abundant. “This was a triggering event. I went onto chat groups, we open-sourced medical supplies, and we started sharing ideas about how to make things ourselves,” he said. He connected with universities who could help him with 3D printers. He mobilized resources. And within weeks, he was producing face shields for his community.

Portrait of Kuldeep Bandhu Aryal in Cox’s Bazar, Bangladesh (August 29, 2021)

Kuldeep Aryal, Cox’s Bazar, Bangladesh

“At first, it was slow. We could only make 40 to 50 per day. The university didn’t allow us to come and go from the lab, so while some spent the night there, others went out looking for raw materials,” he said, describing how there was no down time. While printers slowly churned out face shields, he and his fellow makers formulated hand sanitizer using chemicals they spotted around. “Anything. We had an environment of crisis, with resource constraints,” he said. “We had to figure out how to use what we had, to make whatever we could. And then make it faster.”

 

Months into the pandemic, Kuldeep was making goggles, handwashing stations, and oxygen concentrators, sophisticated machines that are saving lives in hospitals today. His formula is simple: Use open source to design; localize for your market; and then scale. “The hardest thing is not the inventing. It’s figuring out the challenge of production and where the supply chain lives,” he said, matter-of-fact and without fanfare. Invention comes first. Adaptation to local markets next. And adoption—or taking things mainstream—is the ultimate prize. “That initial spark of innovation, we try to build on it and expand, so we can make our innovations common,” he said. “So everyone can benefit.”

 

Kuldeep disavows the notion that catastrophe freezes anyone into a state of victimhood. Instead, he insists, the most challenged people on earth are usually the most resilient. “People with inequities have suffered a lot. But we’ve always suffered. It’s not a new thing. COVID has just been another challenge,” he said, and continued his march forward.

Explore the Data

To learn more about our latest global data on how the world is progressing on 18 measures of health and development, visit our Global Indicators page. Our data and methodology will show you where we’ve made progress and where certain inequities have stalled us across the Global Goals.
Explore the Data
No Poverty
Poverty
Good Health & Well-Being
Stunting
Zero Hunger
Agriculture
Good Health & Well-Being
Maternal Mortality
Good Health & Well-Being
Under-5 Mortality
Good Health & Well-Being
Neonatal Mortality
Good Health & Well-Being
HIV
Good Health & Well-Being
Tuberculosis
Good Health & Well-Being
Malaria
Good Health & Well-Being
Neglected Tropical Diseases
Good Health & Well-Being
Family Planning
Good Health & Well-Being
Universal Health Coverage
Good Health & Well-Being
Smoking
Good Health & Well-Being
Vaccines
Quality Education
Education
Gender Equality
Gender Equality
Clean Water and Sanitation
Sanitation
Decent Work and Economic Growth
Financial Services for the Poor