Paul E. Farmer Butaro Dialogues on Health Equity and Innovation

Bill Gates
July 22, 2026
Kigali, Rwanda
AS DELIVERED

Thank you, Professor Abebe, for that introduction. And thank you to the University of Global Health Equity for hosting me. I’m honored to be here alongside First Lady Jeanette Kagame, and the Ministers of Health, Education and ICT, along with other government officials. I’d like to reflect on the legacy of the man who shaped this place—my good friend Paul Farmer.

A few moments ago, I had a chance to visit Paul’s glade here at UGHE. It’s the garden he imagined for this campus, and the place he was laid to rest. And I had the privilege of planting a tree at his memorial—one of the great California redwoods that Paul smuggled into Butaro. Standing there, I was reminded of the amazing first visit I had to Rwanda. I spent most of the time with Paul. I was here and saw the hospital in Rwinkwavu that was just starting to take shape.

After a long day of meetings, Paul suggested we try and visit the mountains to see the gorillas. I was excited so I changed into casual clothes, put on hiking boots, and we set off. Paul, however, had not brought a change of clothes. So there we were, trekking through the Rwandan jungle, with Paul wearing his suit and tie. We spent the whole time talking about tuberculosis, malaria, and how to design health systems that could really work. When I mentioned to him that he might be overdressed... he just looked confused, and went back to talking about global health.

That’s who Paul was: someone who put all of his energy, all of his life to the issues that mattered to him. Always passionate. Always deeply moral. And always at home—even in the jungle, in a suit and tie.

Paul lived and worked in many places around the world.

Paul had a huge influence on me and the work I'm now doing through the Gates Foundation. I had a great update from his wife yesterday who wishes she could be here and we talked about our shared commitment to global health and to UGHE. I know Paul enjoyed all of his time here and I'm not surprised that he spent his final years here and chose this as his resting place.

He always talked about how the best ideas in global health come from the people they're meant to serve. In the past few days, I've seen powerful examples of how Rwanda is leading the way in this spirit. This morning I met with the leaders from the faith-based network and was impressed to hear their commitment. Not only are they involved in delivering 30% of the health, but through their voice, their trusted voice, they're a key communication channel to make sure that misinformation does not confuse patients and that things are being done on their behalf.

On Tuesday, I was at the National Health Intelligence Center where I saw how Rwanda is leveraging digital systems to really understand the quality of the work it's doing. Those digital systems will be the foundation for the next generation, which will be powered by artificial intelligence.

In fact, Rwanda is in the forefront, working with the Gates Foundation and AI providers to see how it can benefit the health system. Of course, today was also very exciting because I got to meet students here at UGHE. I saw them work through a challenging delivery simulation, and I got to talk through some of the remarkable innovations that have emerged from this university.

Rwanda as a whole has set a very good example. Its public health system – there's a lot that others could learn from. Since the turn of the century, child deaths have fallen by 80%. Maternal deaths are down over 80%. And those are really incredible numbers.

Of course, today we face greater challenges than ever. Progress in Africa as a whole is definitely in jeopardy. So it's a tough time for global health. Around the world, donor countries are not doing debt relief. They're shrinking their aid budgets. And so the leaders here are being forced to do more with less. The immediate consequences of those decisions were swift and devastating.

Unfortunately, last year in the world was the first year that childhood deaths went up since the turn of the century. Not here in Rwanda, but a lot of those additional deaths were in Africa. I sometimes think about what Paul would say in a moment like this. He always believed that where you live should never determine if you live.

In fact, when we talked about the resource trade-offs, he was sometimes offended that we would even talk about, OK, we didn't have enough money to save lives. He's a big believer that we should get to that ultimate place where every life is treated with equal value.

Now, there is a lot of promise as we enter this next era. The Gates Foundation and others are involved in creating many new tools, tools for malaria, TB, HIV and nutrition. And the pace of that innovation will be accelerated by artificial intelligence. So it plays a role not only in the discovery side, but also with you as pioneers in the delivery side. So whenever I look at that pipeline of innovation, I'm thrilled by that.

But in all my years in global health, one of the most important lessons I've learned, which, you know, Paul told me many times, is that it really doesn't matter unless they reach all the people who need them.

AI is a great example of this. You know, if we let things take their normal course, AI, like all advanced tools, will be in the rich countries – the profit motive, the amount customers can pay, the data centers. It will benefit a very narrow part of the world. But that would be a great injustice. And so this idea and the project that many of you are engaged in, that right at the beginning, if anything, we should bring AI to those in need because the most overloaded healthcare workforce in the world, of course, is here in Africa.

And things that help them make decisions, streamline things and show them where we should do more, will save many, many lives. Now, the practicalities of this will be worked out in institutions like UGHE. You know, understanding: Is the local language recognition as good as it needs to be? Are we really addressing the key conditions that are challenging here? And we'll have to take the data and the learning that's only here and imbue that into the system.

Paul Farmer wasn't an innovator in the traditional sense of the word. He loved the idea of new vaccines. He loved the idea of new TB drugs. But right away, he would say – how are you thinking about delivering those in Haiti or Rwanda or any other place where the need existed? For him, he saw everyone as worthy of having great health. What mattered to him were the lives he saved. And so he understood the challenge of delivery – a challenge of delivering vaccines, bed nets and all the new things to come. The truth is, this gap in delivery already is responsible for a significant portion of the deaths that are taking place. This is certainly true in maternal and child health, which is a pillar of the Gates Foundation's work.

Despite the progress here in Rwanda, if we look globally, we still have over 300,000 mothers dying from complications during pregnancy and childbirth. And of course, the vast majority of that is in countries with limited resources. Every year nearly 5 million children die before reaching their 5th birthday. Now this statistic you can view it as good news or bad news. Compared to where we were at the turn of the century, the reduction has been fantastic, almost cutting it in half. And this is the fastest rate of reduction ever in the history of mankind. This is due to a mix of better health systems and also better tools, tools like the pneumococcus vaccine, the pentavalent vaccine, and the rotavirus vaccine. Those are part of what's here when we were able to deliver them to nearly all the children.

And yet 4.8 million is still a tragic statistic. Children in Africa are 8 times more likely to die than children in countries like the United States. And like Paul, we should be infuriated by that. We should find that hard to believe, hard to accept. So it's not a mystery what we need to do. We know the conditions and in many cases we have fantastic tools to help out. So those are the things that the students here are learning about.

I'm thrilled that ultrasound is now coming into the picture, that oxygen therapy systems, including CPAP are getting out very broadly and new approaches to treat post-partum hemorrhage—the number one cause of maternal death, are now being delivered.

Institutions like this one are educating the scientists, researchers and policy makers who will shape the next generation of global health – people who can bridge this gap between innovation and implementation in the spirit that Paul taught us all. If you train somebody at a medical school in a big city, they may not have the understanding of how they can help those in rural communities. Or they might learn how to treat individual patients, but they won't fully understand how we can improve the overall health system.

The health system has got many elements, the doctors, the nurses, the community health workers. I've been fascinated to see how Rwanda has brought that together in a very well-operating system that's delivered incredible results.

Paul Farmer loved talking about the policies with capital. Paul Farmer was as comfortable talking about the policy issues as he was talking with patients. So this school is a testament to his belief that both of those things are incredibly important. UGHE teaches students that caring for patients starts with understanding the community, but it also teaches them how to diagnose complex problems with the larger health system and to treat the root causes, not just the symptoms. This is how many of you will improve the world.

It's a model that I believe others can learn from. I was very excited to learn about the new consortium, the Consortium of Medical Schools in Africa, or CoMSA. CoMSA is very exciting because it brings together top universities to share best practices. This will improve how medicine is taught, how research is conducted, and how care is delivered throughout Africa.

So to the Deans here today, keep sharing resources and best practices, and at the same time, make sure your students understand the unique needs of their patients and their communities. To the Minister of Health joining us, thank you for your leadership. The future of global health will be shaped by the decisions you're making right now.

To invest in the primary healthcare system, to strengthen overall health systems, to build data systems that help you know exactly what's going on and what needs to improve, the young people here can benefit from Paul's example – treat patients with care and remember that you are part of a larger system. The future of global health will be increasingly shaped here in Africa, with Rwanda setting many excellent examples to benefit communities all over the continent.

This isn't my first visit to Rwanda, but it is the first time I've been here since Paul's death. The people of Rwanda gave him a name, Muganga Mwiza. “The good doctor.”

It’s a fitting tribute because he cared for others. He didn’t just save lives. He changed them, including my family’s.

Years ago, Paul took my oldest daughter, Jennifer, to see the work he was doing in Haiti. She met the patients, including a mother in a community clinic, a child who wouldn't have survived without the medication Paul fought to bring to them. And that experience changed her. She went on to study medicine, too, so that she could do the kind of things that Paul did. My youngest daughter Phoebe also came to see Paul here in Butaro and was inspired by him. She met a great teacher here, Dr. Akiiki Bitalabeho, who she still talks about and the inspiration she got to this day.

I miss Paul deeply, but it's very comforting to see his legacy so reflected here. To the students here, every generation of global health needs advocates to face the defining challenge. People like Paul proved that a better world is possible. Our task is to insist on it. I look forward to helping you in all that you can accomplish.

Thank you.