Remarks to the Japanese Parliament

Bill Gates
Tokyo, Japan
November 9, 2018
AS PREPARED

Thank you, all, very much.

It’s great to be back in Japan. When I was working at Microsoft, I visited Japan more than any other country. We chose this as the location for Microsoft’s first office outside of the United States, and there were some years when we did more business here than we did in the United States.

So, I recognize that this is how many of you may know me – through my work at Microsoft.

But for the past decade, I’ve spent most of my time focusing on the work of our foundation – and the fight against global poverty and disease. I’m grateful to have the chance to share with you why I became involved in this effort – and why Japan’s support is so important.

I had never even heard of rotavirus. And I thought, ‘How could something I’d never heard of be killing half a million children every year?’

I read further and learned that millions of children were dying from diseases that had essentially been eliminated in countries like Japan and the United States.

My wife, Melinda, and I always thought that one day we’d start second careers in philanthropy. But the scale of the global health crisis motivated us to act. We established our foundation in 2000, and a few years later, I left Microsoft to focus on philanthropy full time.

The question Melinda and I kept asking was: How could we do this most effectively?

We wanted to make sure that every dollar we invested was doing as much good as possible.

In 2000, we helped finance the creation of an innovative alliance called Gavi. Gavi’s goal was simple: to reach more children in developing countries with vaccines, which would protect them against diseases like rotavirus.

What I like about Gavi is that it focuses on getting maximum return on investment. Gavi pools the demand for vaccines from the world’s poorest countries. Then it works with pharmaceutical companies, developed countries like Japan, and foundations like ours to buy millions of doses at lower cost.

Gavi immunizes 100 million children a year in this way. In the lowest income countries, every dollar invested in those vaccines saves $16 in health care costs and lost wages. And when you consider the broader economic impact of people living longer and healthier lives, vaccines return $44 for every dollar invested.

That’s a lot of money that developing countries can invest, instead, in health clinics, education, and better nutrition for kids. Things that help people lift themselves out of poverty and reduce their need for aid later on.

Gavi helped spark a new era in development aid, one focused on giving efficiently and effectively.

In fact, the same year as Gavi’s founding, the G8 met in Okinawa and began a coordinated effort to fight malaria, tuberculosis, and HIV. These diseases are the greatest killers in low-income countries. And with Japan’s leadership, the G8 established another innovative organization called the Global Fund to purchase and deploy essential medicines and solutions for these diseases.

Of course, Japan has a long history of leadership in global health. A Japanese virologist led the World Health Organization’s effort against smallpox when the disease was finally eradicated. And today, Prime Minister Abe is one of the world’s strongest advocates for universal health coverage.

But Japan’s support of the Global Fund is certainly one of its most important contributions to global health. Because it’s extremely effective at saving lives.

Every $100 million Japan invests in the Global Fund saves more than 130,000 lives. So, your three-year commitment of $800 million will save the lives of more than 1 million people. That’s an incredible return on investment.

There are other diseases of poverty where Japan has also made a big impact.

Consider polio. Thirty years ago, there were 350,000 new polio cases every year. Last year, it was just 22 cases. (Not 22,000 or 2,200. But 22).

Japan has helped in this effort because the Japan International Cooperation Agency has provided significant loans to help reach more children with vaccines that protect them against polio.

My point is this: These kinds of smart investments – to provide vaccines and to fight diseases like polio, HIV, and malaria – have fundamentally improved global health.

The whole story can be told with one statistic: The number of children who live to see their 5th birthday. It’s the best indicator of a society’s overall well-being. That’s because almost all advances in society — better health, education, economic growth — show up as reductions in the childhood mortality chart.

Which is why the following numbers are crucial:

In 1990, 11 million children under the age of five died, mostly from preventable diseases.

In 2016, the number was 5 million.

That’s still a big number, but it’s a decrease of more than 50 percent in a single generation, even though the world population has increased by almost half in that time.

I wish more people – here in Japan and in other countries – were aware of this progress … and of Japan’s contribution to it.

Investing in global health produce outsizes returns and makes a huge difference in the lives of millions of people. Often, it’s the difference between life and death.

I’m here today because I believe we need to keep up these efforts. Your investments matter more than ever because continued progress is not inevitable.

In just the last few months, we’ve witnessed a new outbreak of the Ebola virus.

In some low-income countries, there have been increases in malaria cases.

The largest generation in Africa’s history is at an age when they’re more susceptible to HIV than at any other time.

And the number of people living in extreme poverty might be on the rise again, too. That’s because the poorest countries in the world, mostly in Africa, are experiencing much faster population growth than the rest of the world.

One way to combat the threat of rising poverty and disease is by developing innovative new tools, and Japan is lending its R&D muscle to this effort with the Global Health Innovative Technology Fund. Over the past 6 years, it has established some successful partnerships, including one with FUJIFILM that developed a breakthrough diagnostic tool for TB that works especially well for remote areas.

But we also need Japan’s continued support for other effective initiatives like Gavi and the Global Fund. Over the next few years, we’ll need to ensure they have enough funding to continue doing such a great job. The same is true for the Global Polio Eradication Initiative – and a newer health initiative called the Global Financing Facility, which helps coordinate countries’ investments in women’s and children’s health.

So, if there was ever a time when we need Japan to do more to support global health, it is now.

Japan’s contributions to the fight against poverty and disease have a made a difference. Yet, today only a small fraction of the total development aid Japan gives – about 5 percent a year – is devoted to global health. In the United States, 28 percent of development aid is invested in global health.

I understand that it might seem difficult to set aside more funding for other nations when there are deserving programs here at home. But it’s important to remember that investments in global health are investments in Japan, too.

Strengthening the health care systems of developing nations helps protect Japan and other countries against the spread of new diseases and future pandemics.

Investments in global health are also investments in Japan’s security because helping people lift themselves out of poverty addresses some of the root causes of mass migration and civil unrest in some of the world’s most difficult places.

And investments in global health contribute to Japan’s economy because they help expand international markets. Economic models show that development aid could increase Africa’s GDP by up to 90% over the next 30 years.

Indeed, global health is somewhat similar to business: there is a high return if you invest in innovation and get the strategy right.

Although Melinda and I have been fortunate thanks to the success of Microsoft, we still care about every penny we invest because we believe every person deserves the opportunity to live a healthy and productive life.

I hope you will consider the benefits to Japan of investing more in the fight against poverty and disease.

The future of millions of people around the world depends on it.

And the actions you take as members of the parliament also affect people here in Japan.

Thank you, and I’m looking forward to our conversation.