Inspiring Progress Event in Addis Ababa
Bill Gates
June 2, 2025
Addis Ababa, Ethiopia
AS DELIVERED
Thank you, and good morning. It is fantastic to see the large group here today, and I really appreciate the comments that Graça made. She has been a great leader and an incredible partner, whom I was privileged to work with. I also got to work with President Mandela, who is, of course, one of the most inspirational people ever.
Throughout his life, he showed incredible courage. And now Africa's at a time where they're looking for the next generation of leaders that will provide the great examples like he did.
Today I'm going to talk about the progress that has been made, my optimism for the future, and some of the specific things that we need to do, as well as my commitment to help with the challenges that I am taking on.
Mostly, I like to look forward, you know, look at the new science, look at the progress that can be made, but this year in particular, I find myself looking back on what has been done. This year is the 50th anniversary of Microsoft, the company I founded, which provides the fortune that I'm now giving away. It's the 25th year of the Gates Foundation, and also later this year, I'll celebrate my 70th birthday. I see here a picture from back in 1993, which was one of my first visits to Africa. It was a fantastic trip. It made a real impression on me and made me commit to learn more and to understand the history, the amazing history here.
It was during the 1990s that I was already thinking about what I would do giving back the wealth created by the success of Microsoft to society. And my mom often quoted the biblical statement “to who much has been given, much is expected.”
My parents, who you see here, my dad and mom, shaped my values. They set a great example, they were incredible volunteers, always believed in giving, and they really taught me the belief that all lives have equal value.
This picture shows him here with Warren Buffett, who other than my parents is probably the person who has influenced me the most. He's also unbelievably generous and he's also given a lot to Africa, both through his gifts to the Gates Foundation and the incredible generosity of his children's foundation.
The other picture is a favorite and is when my dad made a trip to South Africa at a time when HIV was not being acknowledged as a challenge throughout the world. There was a lot of denial and incredible stigma.
And so, it was very brave of President Nelson Mandela, together with Jimmy Carter, my dad, to be holding some babies who had been infected with HIV here in Soweto in 2002.
During the 1990s, I was moving on beyond just thinking about computers, which had been my great obsession in my teens and twenties, and thinking about the world at large, what's going on with health and science, and education.
And an article I saw by Nick Kristof in 1997 taught me about the number of kids who are diagnosed with diarrhea and taught me that it's mostly kids in the lower-income countries.
And I was stunned to find out that there actually was a vaccine to treat the main cause of diarrhea, rotavirus, but it was so expensive, it was not available to all the children in the world, and nothing had been done to reduce the cost and raise the money to make that available.
And so, you know, I took that article from Nick and I sent it to my dad, saying, I think this is an area we should learn more about, and maybe we can help out. And so, child survival and child thriving became the primary focus of the Gates Foundation.
And of course, we often talk about millions of deaths and how tragic that is, but that can sometimes take away from the deep emotional connection we feel with a single death. So I've got a short clip here that talks about actual individual deaths and reminds us that this is all the work of both the heart and the head.
A very personal experience I had was being in South Africa, and I was meeting with the parents of the children who had just died. And we were asking those parents to volunteer to have their child undergo what we created a simple procedure called a minimal invasive autopsy to understand what the child had died of.
And I asked the mother why they were willing to volunteer. And she said that they would do anything to make sure that others didn't have to go through what they were going through.
And so they wanted to contribute to that. Now, we can see that most of these under-five deaths are taking place in lower-income countries. And so this is incredibly unjust.
A child born in many parts of Africa has 50 times the chance of dying before the age of five than children in other countries and so from this very beginning, starting in the year 2000 the foundation has learned from our partners in Africa.
We've learned about health, agriculture, education, and we've talked about how can we bring innovation to bear on these problems. Some of the innovation is very scientific, creating new vaccines for malaria, HIV, and tuberculosis.
Some of it is very basic, like how do you organize the primary health care system? How do you engage the citizens and convince them of what kind of health practices will work the best? I've always been inspired by the hard work, you know, even in places with very limited resources, the kind of field work to get solutions out, even in the most rural areas, has been incredible.
Our foundation has an increasing commitment to Africa. Our first African office was here in Ethiopia about 13 years ago. Now we have offices also in South Africa, Nigeria, Kenya, and Senegal.
That's a great way for us to strengthen partnerships.
Looking back on the last 25 years, we have seen incredible progress. The progress in global health is not well known, and yet I consider it one of the greatest things that humanity has done.
The reduction in under-5 deaths from just under 10 million to now well under 5 million during these 25 years is really mind-blowing. It is more than twice as fast as the reduction of deaths than in any period in history.
And there's some very specific things that were done to get this result. Early in the foundation's history, we were a founder of a group called Gavi that was there to help buy vaccines. We spent the money to make sure the cost of that rotavirus vaccine went down from $30 to under $2. And leaders in countries made sure that those new vaccines got adopted and looked into their primary healthcare system to see, okay, what percentage of the children were being reached and what should they do to get that up towards 100%. There are many exemplars in this work, including Ethiopia.
For sub-Saharan Africa as a whole, deaths have been cut. And Ethiopia has done even better than that, achieving a cut of more than half. So we've gone from about 400,000 now down to 183,000.
So how did this happen? Well, the government made health care, and in particular primary health care, a priority by creating the idea of health posts and growing those from about 1,000 in 2005, more than 15,000 today. They also used them to track the supplies and make sure the vaccines were getting out. They hired an incredible cohort of these health extension workers. And I want to recognize the amazing health extension workers who are here today.
Your work has saved lives and I have enormous respect for the great work you do. Thank you.
Another area that is a global challenge, but a particular challenge in Africa was the spread of HIV. Deaths from HIV peaked soon after the turn of the century and have now fallen from the peak by 70%. Again, this was achieved through partnerships. In the early years of the foundation, right after helping to create Gavi, we helped create the Global Fund, and it pools money from Gates Foundation and rich countries to help countries, including those in Africa, to fight three diseases, HIV, tuberculosis, and malaria.
And so it's another great example of solidarity. And the person who really got the word out to help this come together the great way it did was Kofi Annan, who exercised great moral leadership as Secretary General of the United Nations.
Again, there are countries that showed the way. In Zimbabwe, for example, deaths from HIV fell by over 80%. They had at the peak one of the largest epidemics, but they took it very, very seriously. And now they've achieved having 95% of everyone who has HIV know their status, 95% of those people are on treatment, and 95% have full viral suppression. And that's actually the best of all countries in the world to achieve all three of those goals.
And that means that the disease numbers will continue to go down. Now, the Gates Foundation is funding lots of new tools for all of these diseases. For example, in the case of HIV, we now have a shot that, if someone gets that shot, they're protected for the next six months. So getting that shot twice a year will protect you for the entire year. So we'll be rolling that out over the next year.
Malaria, of course, is another big challenge, particularly in Africa. And we haven't made as much progress as we have on HIV. We always have setbacks. The parasite develops through drug resistance. The mosquitoes developed insecticide resistance to the bed nets, and the spray doesn't have as much effect.
And so it's tough. We need to keep innovating. Bed nets, we now have dual insecticide nets. They started out being a lot more expensive, but we've been able to drive the price of those down to the same price, which is under $5.
Mozambique has done particularly great work in cutting malaria deaths, and a lot of that is day-to-day data gathering. Diagnosing the patients, creating maps, and using the resources very effectively. Every time you treat a patient and clear their malaria, that reduces the number of infections that take place for other people.
Here, there's an even more exciting tools in the pipeline, including new ways of killing mosquitoes or making them unable to carry the malaria parasite. And so as our partners are here in Africa, a lot of African scientists are testing and we're finding those tools, getting them ready for broad-spread rollout, I believe there's a real possibility over the next 20 years to completely eradicate malaria.
And that would be a huge achievement. The disease that we're actively in the throes of the – hopefully - last years of eradication in polio. This effort started in 1988, well before there was a Gates Foundation.
It was in 1996 that Nelson Mandela and the organization that would become the AU launched the Kick Polio Out of Africa campaign. The number of cases has come down worldwide.
In 1995 we had 60,000, now we're under 1,000. Polio looked very difficult to get rid of in Nigeria, and it was only through great leadership but people like Dr. Mohamed Pate, who's now the Minister of Health there, that this was successful.
I partnered with generous leaders like Aliko Dangote to work with the traditional and religious leaders throughout the country, but particularly in the north, to get the word out about the importance of the polio vaccine.
The main type of polio virus was completely eliminated from all of Africa in 2016, including in Nigeria, where it looked like we might not succeed. We still have a variant of polio that's circulating, and so now we have to take all of the things we did before and double down and get rid of this variant to have that trial be fully completed.
Although the Gates Foundation does most of its work in health, with new tools and helping pilot delivery programs, we also do a great deal of work in agriculture. And when we first got started, I didn't understand how important agriculture is.
It's the backbone of the economy. It's also key to helping kids be fully nourished. That makes a big difference. And giving those farmers all the information and tools they need is a key goal for us. If they had the best weather data, pricing data, information about the best seeds to use, if the seeds were improved a great deal, if they could economically get fertilizer, and the best fertilizer exactly matched to the needs of their soils, we would have great productivity increases. In fact, we're very committed to make that happen.
The goal is to have Africa go from being a net food importer to being a significant net food exporter even in the face of population growth and climate change.
We know this is achievable. One great example that's already made a huge difference is in poultry. Ten years ago, we partnered with African partners to get a fantastic chicken, much bigger, lays more eggs, bigger eggs, that are far healthier, here into Africa. And thanks to many partners, including here in Ethiopia, MIDROC Investment Group, across the continent, over 140 million of these birds have gotten out into rural communities, and we can grow that even further.
So innovation is part of the solution. The foundation works in a lot of other important areas. I won't be able to touch on them all. One is what we call digital public infrastructure.
That's having each government have an identity scheme that works well, being able to transact and save very easily from your mobile phone. So far, we have half the countries in Africa implementing those systems.
We think it'll spread eventually to all of the different countries. So not only do you domestically have instant payment, but even in terms of integrating the African economies, these digital payments make it easy to work across borders.
Another important area where we've made progress is in neglected tropical diseases. And 23 countries in Africa have eliminated at least one of these diseases. For example, Togo became the first country in the world to eliminate four NTDs as public health problems by doing a great job of getting the Mass Drug Administration medicines out to all of their people.
Likewise, TB, tuberculosis is a big area, we have a trial taking place in many countries of a new vaccine, and our partners, our scientific partners in South Africa have played an absolutely central role in advancing that work.
Well, why am I optimistic? Well, I am a technologist at heart. I love backing scientists with great new ideas. And the latest technology that we're all hearing about is artificial intelligence. And I can say to you that this will be deeply important. It's an incredible opportunity. It brings challenges with it, but as we drive it forward, it will make a huge difference in health, education, and agriculture.
And now I'm seeing young people in Africa embracing this, and thinking about how it applies to the problems that they want to solve. So in the same way that Africa largely skipped traditional banking and traditional telecommunications, now you have a chance, as you build your next-generation healthcare systems, to think about how AI is built into that. To empower your farmers, to make sure that an AI can advise, giving better information to even the farmer with the smallest landholding, better advice than even a farmer in a rich country is getting today.
Already, we're seeing good examples of this, we're using the AI ultrasound as a very cheap device, with AI interpretation. So this device here now is an ultrasound, it's not a big, expensive box. You plug this into your cell phone and running on that phone will be an AI algorithm so that early in a pregnancy the software will tell you, is this going to be a difficult delivery? And so, if so, you can make the effort to get to a place that can do a C-section. And for over 90% of pregnancies, it will say this will be a normal delivery, and so you don't have to go to that trouble.
And that's just one of many areas where AI is now finally stepping in and helping provide great health services. Rwanda is one place where this is being pioneered, and as that works, we'll roll it out throughout the continent.
And so the Gates Foundation wants to find the best AI thinkers, back them, and make sure that AI is not one of these technologies that is mostly in the rich countries, and you have to wait 10 or 20 years before it gets rolled out. In fact, you could say that if equity were served that it should roll out here first because the need for more medical capacity, educational capacity, and agricultural information is probably stronger here than anywhere else in the world. So we can work together to make that happen.
Now, we're sitting here at a time, actually, of a significant crisis in part of the system where there's been partnership between countries. A lot of cuts are being made in foreign aid programs. Some of those cuts are being made so abruptly that there are complete interruptions in trials, or medicines are still sitting in warehouses and are not available. And these cuts are something that I think are a huge mistake.
In fact, I'll be as strong a voice as I can to get as much of that restored as possible. It's coming also at a time when the fiscal indebtedness of many countries has them paying out more in interest than they are on things like health and education.
And so we do see that in these next several years, for the first time in 25 years, the number of children who die will go up instead of going down. Now, we should all feel a sense of anger about that, but we should also make sure that we're doing the best we can, not only to make the case, but to use innovation, to use prioritization to make sure that we get back to reducing deaths as soon as possible.
As Graça said, it's time for Africans to leverage all the resources at their disposal and take the destiny of the people into their own hands. And you know, we already see a lot of steps being taken.
Nigeria, Tanzania, Malawi, all shifting budget priorities to make sure that basic primary health care, basic meds, and treatments are not cut off as much as these aid cuts would otherwise generate.
We need to prioritize well, we need to work together, and I do believe we will get back to good progress. Part of this is prioritizing primary health care. A primary health care system doesn't have to be expensive.
It needs to be well-staffed, well-run, it needs to use data. Zambia here is a fantastic example. Even though there's been all sorts of financial challenges, their child mortality rate has gone down very quickly. And part of that is that they both prioritize primary health care, and they run the workforce. They train them, they make sure they're there, and so the kids are getting the vaccines and that's what's resulted in that reduction in mortality.
My commitment is to be a partner through the Gates Foundation. I recently made a commitment that my wealth will be given away over the next 20 years. And so you can see, you know, I'm extremely lucky. My wealth has gotten to a very high level here. And now, by accelerating my giving, I will have the Gates Foundation take all of those resources.
And in fact, one thing that I haven't said publicly before is that if we think about the priorities and the great partnerships we have, the majority of that funding will be spent on helping you address challenges here in Africa.
The goals here are pretty basic. They really speak to our values. Mothers should survive delivery. Babies should survive past their fifth birthday, kids should be well nourished. Many of these infectious diseases should go away, and the rest within 20 years should be at a very low level.
And by unleashing the human potential through health, through education, every country in Africa should be on a path to prosperity. And that path is an exciting thing to be part of, creating that. So that's how I intend to focus all of my work for the rest of my life, because there's nothing more important.
Thank you.