bill gates annual letter 2012

8/12/2019 Bill Gates Annual Letter 2012

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Annual Letter

from Bill Gates

Carta Anual de

Bill Gates

Jahresbrief von

Bill Gates

Lettre annuelle

de Bill Gates

20

12


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In Guleria Village, talking to a farmer in a basa,a temporarystructure that provides shelter in the fields (Bihar, India, 2010).


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Troughout my careers in sofware and philanthropyand in each o my annuallettersa recurring theme has been that innovation is the key to improving the world.When innovators work on urgent problems and deliver solutions to people in need, the resultscan be magical.

Right now, just over 1 billion peopleabout 15 percent o the people in the worldlive inextreme poverty. On most days, they worry about whether their amily will have enough ood toeat. Tere is irony in this, since most o them live and work on arms. Te problem is that their arms,which tend to be just a couple acres in size, dont produce enough ood or a amily to live on.

Fifeen percent o the world in extreme poverty actually represents a big improvement. Fify

years ago, about 40 percent o the global population was poor. Ten, in the 1960s and 1970s, inwhat is called the Green Revolution, Norman Borlaug and other researchers created new seedvarieties or rice, wheat, and maize (corn) that helped many armers vastly improve their yields.In some places, like East Asia, ood intake went up by as much as 50 percent. Globally, the priceo wheat dropped by two-thirds. Tese changes saved countless lives and helped nations develop.

We have the ability to accelerate this historic progress. We can be more innovative aboutdelivering solutions that already exist to the armers who need them. Knowledge about managingsoil and tools like drip irrigation can help poor armers grow more ood today. We can alsodiscover new approaches and create new tools to undamentally transorm armers lives. But wewont advance i we dont continue to und agricultural innovation, and I am very worried aboutwhere those unds will come rom in the current economic and political climate.

Te world aces a clear choice. I we invest relatively modest amounts, many more poor armerswill be able to eed their amilies. I we dont, one in seven people will continue living needlesslyon the edge o starvation. My annual letter this year is an argument or making the choice tokeep on helping extremely poor people build sel-sufficiency.

My concern is not only about arming; it applies to all the areas o global development andglobal health in which we work. Using the latest toolsseeds, vaccines, AIDS drugs, andcontraceptives, or examplewe have made impressive progress. However, i we dont makethese success stories widely known, we wont generate the unding commitments needed tomaintain progress and save lives. At stake are the uture prospects o one billion human beings.

Innovation in Agriculture

Te private market does a great job o innovating in many areas, particularly orpeople who have money. Te ocus o Melindas and my oundation is to encourage innovation inthe areas where there is less profit opportunity but where the impact or those in need is very high.Tat is why we have devoted almost $2 billion to helping poor arm amilies, most o which are ledby women, boost their productivity while preserving the land or uture generations. Tose undsare invested in many areas o innovation, ranging rom sustainable land management, to betterways to educate armers, to connecting armers to unctioning markets.

We do all these things with one goal in mindhelping people like Christina Mwinjipe, a armerI met last year in anzania. Christina supports her amily by arming cassava, a staple crop thatprovides a basic diet or more than 500 million people worldwide. (When dried to a powder,cassava is known as tapioca.) In the past two years, Christinas crop has been invaded by twocassava diseases. Te leaves o some o her plants are curled and withered, and covered in thewhite flies that carry mosaic disease. Te roots o other plants are rotted by brown streak disease.Because o these diseases, she is depleting her savings to buy cassava to eed her three children.

2012 Annual Letter from Bill Gates 1


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Christina Mwinjipe inspects her cassava crop (Mapinga Village, Tanzania, 2012).

*The Food Price Index weighs export prices of a variety of food commodities around the world in constant U.S. dollar prices, 2000=100.

Food

PriceIndex*

Food Prices on the Rise

Source:World Bank Global Economic Monitor (GEM) Commodities


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Her oldest son just passed his examinations to enter secondary school, but she doesnt knowwhere shell find the money to pay his ees. She is not sure what she will do about ood when hersavings run out.

For Christina and other small armersand or hundreds o millions o extremely poor peopleliving in slums in big citiesgetting ood is the most pressing daily concern. And ood is strongly

connected to another constant worry: basic health. Te lack o adequate nutrition is a key reasonwhy poor children so ofen die o diseases like diarrhea that richer and better-ed children areable to fight off. Poor nutrition in childhood also prevents the development o both the brainand the body, severely and irreversibly limiting childrens ability to grow, learn, and becomehealthy, productive adults. Ultimately, there is very little in Christinas lieor her childrenslivesthat doesnt depend on her cassava crop.

Farming is a great example o something critical to the poor that gets very little attention in richcountries. Back in the 19th century, the majority o people in the United States worked inagriculture. Now less than 2 percent o the workorce is involved in arming, and less than 15percent o U.S. consumer spending goes to ood. Farming issues rarely make the news. Teexceptions are when ood is contaminated, when government subsidies are being debated, or

when there is a amine like the current one in the Horn o Arica.

Despite the rich worlds distance rom arming, ood-relatedissues are important or all o us. In the 1960s and 1970s, whenI was in high school, people worried that we simply couldntgrow enough ood to eed everyone in the world. A popularbook that came out in 1968, Te Population Bomb by PaulEhrlich, began with the statement: Te battle to eed all ohumanity is over. In the 1970s hundreds o millions o peoplewill starve to death in spite o any crash programs embarkedupon now. At this late date nothing can prevent a substantialincrease in the world death rate Fortunately, due in large part

to the Green Revolution, this dire prediction was wrong.

But the worlds success in warding off amine led to complacency.Over time, governments in both developed and developingcountries ocused less on agriculture. Agricultural aid ell rom17 percent o all aid rom rich countries in 1987 to just 4 percentin 2006. In the past 10 years, the demand or ood has gone upbecause o population growth and economic developmentaspeople get richer, they tend to eat more meat, which indirectlyraises demand or grain. Supply growth has not kept up, leadingto higher prices. Meanwhile, the threat o climate change isbecoming clearer. Preliminary studies show that the rise in

global temperature alone could reduce the productivity o themain crops by over 25 percent. Climate change will also increasethe number o droughts and floods that can wipe out an entire season o crops. More and morepeople are raising amiliar alarms about whether the world will be able to support itsel in theuture, as the population heads toward a projected 9.7 billion by 2050.

I believe these new dire predictions can be wrong, too. We can help poor armers sustainablyincrease their productivity so they can eed themselves and their amilies. By doing so, they willcontribute to global ood security. But that will happen only i we prioritize agricultural innovation.

Agricultural Research

Given the central role that ood plays in human welareand national stability, it isshockingnot to mention short-sighted and potentially dangeroushow little money is spenton agricultural research. In total, only $3 billion per year is spent on researching the seven mostimportant crops. Tis includes $1.5 billion spent by countries, $1.2 billion by private companies,and $300 million by an agency called the Consultative Group on International AgriculturalResearch (CGIAR). Even though the CGIAR money is only 10 percent o the spending, it iscritical because it ocuses on the needs o poor countries. Very little o the country and privatespending goes toward the priorities o small armers in Arica or South Asia.

Proportion of Farmers inRich Countries Declining

Sources:USDA National Agriculture Statistical Service (1850-1990)and the International Labour Organization (2000-2008)

By comparison, the proportion of farmers in mostdeveloping countries is still high.

%o

fworkforceinagricu

lture

U.S.

Uganda

India

Brazil



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Sources:World Bank 2009; U.S. Department of Agriculture 2009; Euromonitor International

The Poor Spend a High Percentageof Their Income on Food

Average totalhousehold expenditure

U.S.

U.K.

FRANCE

S. AFRICA

BRAZIL

INDIA

KENYA

Percent of householdexpenditure spent on food

,

,,

, ,

Above:Stalks of wheat at a Ug99 wheat stem rust nursery. Bottom: Healthy and diseased cassava, side by side.

CornellUniversity

DonaldDanforthPlantS

cienceCenter


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Tis shortage o unds or research is particularly worrying because o the increasing prevalenceo plant diseases, such as those destroying Christina Mwinjipes cassava plants. Just like humans,plants get attacked by viruses, bacteria, and ungi. Tey also have to deend themselves againstinsects or animals, but unlike humans they cant run away rom their predators. Plants havedeveloped sophisticated systems or deending themselves that we are just starting to understand.

One amazing discovery is that in some species when one plant is attacked it gives off a scent thattells other plants to ocus their energy on deending themselves rather than on growing.

Because armers plant seeds that give them the highest yields, the diversity o crop varieties infields is quite limited. Tis creates a perect opportunity or disease to spread. A amous exampleo this is the potato blight that spread across Europe in the 1840s and led to mass starvation inIreland. Less well known is the southern corn lea blight that swept through the United States inthe early 1970s. Fortunately, in that case, the United States had sufficient strategic reserves toavert a crisis.

Norman Borlaug, Nobel Prize winner and ather o the Green Revolution, first got involved inplant science afer he heard a proessor give a speech entitled Tese Shify Little Enemies TatDestroy Our Food Crops. Te Rockeeller Foundation enticed Borlaug to move to Mexico,

where he created new varieties o wheat that were resistant to a ungus called wheat stem rust. Itwas only afer he got there that he figured out additional strategies to increase wheat productivity.Borlaug was always concerned that new orms o wheat rust would emerge. Unortunately, hewas proven right in 1999 when a new and extremely virulent wheat rust called Ug99 was oundin Uganda. Tough Ug99 is still mostly in Arica, it has jumped the Red Sea and is now beingound in Iran and Yemen, on its way toward India.

Te response to Ug99 started slowly, but great work by a collection o experts, includingresearchers in Ethiopia and Kenya, has led to new varieties with some level o resistance. A hugeeffort is being undertaken to make sure that the new resistant varieties are adopted broadlybeore the disease moves into Asia or the Americas.

Another area where scientists need to do a lot more study is the effects o climate change onagricultural productivity. It looks like there may be varieties o rice and other crops that can dealwith the higher temperatures and weather variations better than todays plants. Some plantvarieties actually benefit rom the increased CO2 levels, although there is no clear data on howsignificant this will be. Early greenhouse studies were very promising, but field studies haveshown much smaller effects. Te world must invest in a variety o techniques to help poorarmers deal with weather impacts better than they can today.

For example, when I was in India in March I met with about 20 rice armers who had recentlyswitched to a new rice seed called Swarna-Sub1, which is both very productive and can survivein flooded fields. Teir rice fields get flooded every three to our years, and in past flood yearsthey ended up with almost no ood to eat. Now, these armers can eedtheir amilies no matter the weather. Currently, 4 million tons o rice arelost to flooding every year in Bangladesh and India. But as armers in theregion adopt Swarna-Sub1, they will grow enough extra rice to eed 30million people.

Fortunately, there are reasons to believe that the chronic underunding oresearch in agriculture is starting to changeand that there will be morebreakthroughs like Swarna-Sub1. One approach that looks promising isinnovative partnerships with private companies where the companiesdonate proprietary assets in which they have invested hundreds omillions o dollars, as well as their expertise, to help make appropriatevarieties available royalty-ree to poor armers. Other key partners arerapidly growing countries like Brazil and China, which bring not only new

resources but also deep experience in helping poor armers at home.Brazil is a leader in soybeans, cassava, and tropical soils. China is a leaderin rice and armer education. Tis year the oundation entered into modelagreements to work with both countries. Rice being tested at a crop science

facility (Hyderabad, India, 2011).



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Dr. Abdel Ismail inspects rice varieties being tested for flood tolerance (Laguna, Philippines, 2008).

CROP DESCRIPTION

CassavaA starchy root that must be processed before eating because it contains smalltraces of cyanide; often grated, dried, and roasted to make garri, a flour; theleaves are eaten as vegetables in a stew.

Maize (corn)A cereal crop eaten all over the world; in East Africa, traditionally cookedinto a porridge called ugali, which is sometimes rolled into a ball anddipped into sauces and stews.

MilletA group of grains, including finger and pearl millet, used to make a widevariety of foods: porridge, breads, and couscous; often used to make beerand non-alcoholic malt beverages.

SorghumA coarse cereal commonly used to make a wide variety of foods: porridge,flatbreads, and couscous; often used to make beer and non-alcoholicmalt beverages.

YamA starchy tuber commonly boiled and pounded; also dried into chips that aremilled into flour and prepared as a meal called amala; not to be confused withsweet potatoes, which are called yams in North America.

Five Important African Crops

IRRI,ArielJavellana


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Tere is also an extremely important revolutionbased on understanding plant genestakingplace in the plant sciences. Te tools that enable this revolution were created to help cure humandiseases. Te field o agriculture is just now in the process o figuring out how to take advantageo these tools, but its clear that they will greatly accelerate the pace o plant research. It is hardto overstate how valuable it is to have all the incredible tools that are used or human disease to

study plants.Historically, increasing the productivity o a crop meant finding two seedvariants, each with some desirable and undesirable characteristics, andcrossing them until you get a combination with mostly the goodcharacteristics o the two parents. Tis required actually growing tens othousands o plants to see how they develop in different growing conditionsover timeor example, when water is plentiul and when it is not.

Now the process is quite different. Imagine the analogy o a large publiclibrary with rooms ull o books. We used to have to use the card catalogueand browse through the books to find the inormation we needed. Nowwe know the precise page that contains the piece o inormation we need.

In the same way, we can find out precisely which plant contains what geneconerring a specific characteristic. Tis will make plant breeding happenat a much aster clip. Te private sector has moved the astest to use newapproaches, but academic groups, including a Chinese group called BGIthat has more sequencing capability than any other group in the world,are catching up.

When I was in anzania meeting Christina Mwinjipe, I also met Dr. Joseph Ndunguru, a plantscientist leading a project to fight the mosaic and brown streak diseases that are attackingChristinas cassava crop. Dr. Ndunguru is part o a new generation o Arican scientists buildingup the capacity to do innovative science in Arica. Dr. Ndunguru was offered a high-paying jobin South Arica, but he chose to keep working or the anzanian national program. I asked him

why, and he replied that the work he was doing with the national program was the best way hecould connect state-o-the-art science with the needs o the local armers.

When I talk about innovation, it can be abstract or some people. But the direct link betweenthe challenges Christina aces when her crop is destroyed and the solutions that Dr. Ndunguruis working on every day makes it very concrete. Disease-resistant cassava is an answer toChristinas prayers, and I look orward to the day when Dr. Ndungurus work is done and I cango back to anzania and see Christinas field thick with healthy cassava plants. Tat is why I saythat innovation has been and will continue to be the key to improving the world.

A woman weighs bananas at theMaruyu agribusiness services center(Murango, Kenya, 2011).

Dr. Joseph Ndunguru researches crop samples in his lab (Dar es Salaam, Tanzania, 2012).



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Top:Attending the GAVI Pledging Conference in London withJens Stoltenberg, Prime Minister of Norway; David Cameron,U.K. Prime Minister; Ellen Johnson Sirleaf, President ofLiberia; and Andrew Mitchell, U.K. Secretary of State forInternational Development (London, England, 2011).

Bottom: Children wait to be vaccinated with abrand new vaccine that protects against meningitis A(Ouagadougou, Burkina Faso, 2010).

PATH,

GabrielBienczycki


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Global Health

Most o the oundations resources go to global health issues, and our guidingprinciples or those investments are the same as or agriculture: Innovation is the means, andequity is the end goal. When Melinda and I started this work more than a decade ago, we wereinspired by the conviction that all lives have equal value. So one o the first things we investedin was vaccines, which protect all children who receive them, no matter how rich or poor theymay be. In short, vaccines work. wo years ago, Melinda and I called on the global healthcommunity to make this decade the Decade o Vaccines.

Te organization responsible or helping poor countries introduce new liesaving vaccines iscalled the GAVI Alliance. Last summer, GAVI hosted a meeting to get pledges rom donorcountries and organizations. Te goal was to raise at least $3.7 billion over five years, and we knewit wasnt the ideal time to be asking or that kind o money. Troughout the spring, we reallydidnt know i we were going to make it. Finally, a ew weeks beore the conerence began, thepledges started trickling inand they were consistently at the top o the range wed expected.

On the last day, we were tallying up the numbers as they came in to see what the total would be.GAVI ended up receiving $4.3 billion in pledges.

Because o that money, the poorest inants in the world will start receiving the same vaccinesthat inants in rich countries receive. Due to donors generosity and to significant price reductionsrom vaccine manuacturers, GAVI is now supporting two relatively new vaccines, rotavirus (toprevent the leading cause o diarrhea) and pneumococcus. By 2015, these vaccines will prevent190,000 diarrheal deaths and 480,000 respiratory deathsnot to mention improving the overallhealth o hundreds o millions o children. Te money that has been pledged to GAVI will save4 million lives by 2015.

Tats why I think o June 13, 2011, the date o the pledging conerence, as a historic day or

global health equity. It was an emotional moment or Melinda and me. We were happy that ouroundation played a role in helping the world reach that milestone. But what really moved uswas the act that so many partners share our vision o an equitable world and are willing to putmoney behind it, even in these tough times. When people know the kind o impact theirgenerosity has, they are not only willing but eager to help.

Tere were other huge milestones in global health last year. Tere were also a ew setbacks. Inthis section o my letter, I will talk about those milestones and setbacks, the challenges that lieahead, and the solutions that excite me most.

Vaccines

Tere are still years o work to be done to introduce the diarrhea and pneumoniavaccines into every country. Moreover, global coverage o basic childhood vaccines is around 80percent, which is good compared to many other health interventions but leaves one out o fivechildren unprotected. We need to recreate the high-level political ocus that this issue receivedduring the 1970s, when dedicated effort brought us rom just 20 percent coverage to 80 percentcoverage in most countries in just a decade.

When I spoke at the World Health Assembly last May, I announced that I was creating the GatesVaccine Innovation Award. We were pleased to receive 117 nominations encompassing a lot oamazing work. Vaccines are the only high-technology product that needs to be delivered toevery single child. o miss zero children, it takes an incredible amount o ingenuity, and thatswhy we created the award.

I am pleased to announce here that the first award will recognize the work o Dr. Asm AmjadHossain, a district immunization medical officer rom Bangladesh. In 2009, Dr. Hossain wasassigned to two districts where immunization rates were 67 and 60 percent, respectively. In2010, they were 85 and 79 percent. Tese rapid improvements were the result o Dr. Hossainsinnovative approach to running an immunization program. He instituted a process o registeringpregnant women with their expected date o delivery, location, and phone number, so vaccinators



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Top:Polio vaccinators crossing the Ganges River on the lastday of the polio campaign(Bihar, India, 2010).

Bottom: Girl receives polio drop in the Fulani settlementin Mashakeri Village (Kebbi, Nigeria, 2011).


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knew when children were born, where they were, and an easy way tocontact their mothers. He provided annual schedules or vaccinesessions to make vaccinators more accountable to the communityand had the vaccinators put their phone numbers on the childrensimmunization cards, so parents with young children could get in

touch with a health worker. Tese may seem like small innovations,but they show how looking at old problems in new ways can make aproound difference. Improvements like these are spreading to otherlocations because o the commitment and creativity o Dr. Hossainand many others like him. Delivering liesaving vaccines takes thededication o many well-known players like GAVI, the World HealthOrganization, and UNICEF; government officials; and perhaps mostimportantly hundreds o thousands o heroes on the rontline likeDr. Hossain.

Polio

Te oundations top priority remains helping to complete the eradication o polio,perhaps the best-known vaccine-preventable disease in the world. I spend a lot o my timelearning about the disease and being an advocate or doing what it takes to end polio. At the starto 2011, poliovirus was still spreading in three areas: 10 countries in Arica (with viruses thatoriginated primarily in Nigeria), Aghanistan and Pakistan, and India.

Now India has reached a huge milestone. Te country had only one case in 2011, which wasrecorded on January 13 in West Bengal. So on January 13, 2012, India celebrated its first year obeing polio ree. Te challenge in India was mind-boggling. Its hard to imagine how you woulddesign a polio campaign that reached every Indian child. More than a billion people live in thecountry. Massive numbers o amilies migrate constantly to find work. One o the largest states,Bihar, is flood-prone. In some cases, the vaccine didnt work as well as it had in other parts o the

world, probably because o malnourishment, diarrhea, and other illnesses. But the governmentkept raising awareness and improving the quality o its campaigns, even in the toughest locations.Te Indian government deserves special credit or this achievement.

In 2012 we need to keep India and all the other places that are polio ree rom getting re-inected.Te biggest ocus or 2012 will be improving the polio vaccination campaigns in Nigeria, Chad,the Democratic Republic o Congo, Aghanistan, and Pakistan. I recently visited Chad andNigeria to meet with leaders there, and its clear that we have high-level political support. Still,deploying high-quality vaccination teams and educating parents so that every single child isvaccinated will take a lot o work. In Nigeria our biggest problems are low-quality campaignsand the act that some parents dont trust that the vaccine is sae. In Pakistan these problems arecompounded by the security situation.

It will be challenging to continue raising the approximately $1 billion per year it takes to run theglobal campaign. Last year the United States, the United Kingdom, Australia, Japan, Canada,Norway, Saudi Arabia, the Crown Prince o Abu Dhabi, and Rotary International providedsubstantial contributions. Rotary continues to be the heart and soul o polio eradication,supporting the program directly while also taking on a larger role in encouraging other donorsto give more. A new partner, FC Barcelona, is spreading the message o polio eradication tomillions o ootball ans across the globe.

We are continuing to invest in studies about how polio spreads and trying to model where weneed to intensiy the vaccination campaigns. We are also working on new vaccines. Findingevery last poliovirus requires good tools along with trained and motivated workers in everysingle country.

Tese are enormous obstacles, but the success o the polio eradication program in India and 90other countries gives me confidence that we can triumph in these final challenging countriesand end polio once and or all.

Melinda meets with Dr. Asm Amjad Hossain,the recipient of the first Gates VaccineInnovation Award (Dhaka, Bangladesh, 2012).



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Top:Nineteen-year-old Bayeza Manzini speaks to soccerplayers about the benefits of circumcision (Matsapha,Swaziland, 2010).

Bottom: Nutritionist Claudette Kayitesi counsels FranoisIyamuremye as he receives his monthly antiretroviralmedication (Kigali, Rwanda, 2011).


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AIDS and the Global Fund

Te AIDS community has three big goals:

1. Reduce the number of people getting infected.By 2015, the goal is to cut inections to 1million per year, which would represent a 68 percent drop rom the peak a decade ago.

2. Provide drugs for everyone who needs them, so those with AIDS can live longer andmore productive lives. Last year, 1.8 million people died o AIDS.

3. Find a cure.Although there are people working toward a cure, it is viewed as so difficultthat we cant count on ever having one.

Tere are many ways to tackle the first goal: reducing inection. Tese methods can workindividually and in combination. One approach is to convince people to avoid risky behavior.Education efforts are important, and they are getting more targeted, but their impact is uncertain.

A second approach is male circumcision, which reduces HIV transmission by up to 70 percent.Funding or circumcision is finally being prioritized, since the cost is quite low and the protectionis lielong. Over 1 million men ages 1549 have been circumcised in 14 Southern and EasternArican countries with large AIDS epidemics, but that is only 5 percent o the total number whocould benefit rom the procedure. Even in the ancient practice o circumcision, innovation hasthe potential to make a big difference. Te new PrePex and Shang Ring devices simpliy theprocedure and make surgery unnecessary. Te first studies suggest that these devices are bothsae and effective. (I will keep this letter G-rated by leaving out the pictures o how the deviceswork.) Botswana, Kenya, South Arica, and anzania are starting to show leadership by gettingthe message out to all young men that it is important to get circumcised. Kenya has made themost progress, circumcising 70 percent o eligible men. I will be very disappointed i, by 2015,any ewer than 15 million young men have chosen to protect themselves and their partners bygetting circumcised.

A third approach to prevention is to come up with an injection or pill or gel that reduces an

uninected persons chance o becoming inected. Te final results o studies o a number othese tools were reported in the last 18 months. In studies where the patients used the tool asthey were supposed to, the results were quite good. However, in most studies the levels o usagewere low and thus the overall results were disappointing. Tis has the field thinking hard abouthow you could motivate better adherence or create a tool that requires less effort rom thepatient. One example in early development is an injection that lasts 30 to 90 days. I think we willsolve the adherence problem, but we are going to have to get medical scientists, social scientists,community representatives, and regulators working together. We have to develop and testoverall delivery systems, including communication, support, and incentives, in ways that gobeyond what a medical trial alone typically does.

A ourth approach, called treatment or prevention, is to give antiretroviral (ARV) drugs to

people with AIDS earlier in the course o their disease, greatly reducing the chance that they willinect others. Tis is already done or pregnant mothers to reduce the chance o inecting theirbabies during delivery or through breast-eeding. Te field has a goal o getting drugs to 90percent o HIV-positive mothers by 2015, virtually ending mother-to-child transmission. Temain problem with treatment or prevention is that most people who are inected with andtransmitting HIV dont know they are inected, so you wouldnt know to give them drugs. In orderto realize the ull potential o treatment or prevention, we need to encourage widespread HIVtesting, which will require developing a reliable, inexpensive saliva test that can be used privately.

One urther approach to prevention is an AIDS vaccine. On this topic, this years news is verysimilar to last years. Te scientific understanding o the AIDS virusits shape, how it enterscells, and how we can use antibodies to block ithas advanced more than expected. However,

plans or conducting trials o different constructs are still not as aggressive as they should be,given how game-changing a vaccine would be. It is still possible to have a vaccine within 12years, but it will take some luck and better planning.

It is exciting to have so many prevention approaches available, and to be making progress on mosto them. Funding continues to be a serious concern, but I am optimistic that the field willdevelop combined approaches to significantly bring down the rate o inection.



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Zabibu Athumani and her son rest under an insecticide-treated bednet (Bagamoyo, Tanzania, 2011).

The Global Fund Has

Saved Millions of Lives

AIDS TREATMENT

People receiving

antiretroviral therapy

MALARIA PREVENTION

Insecticide-treated

nets distributed

TB TREATMENT

Cases detected and treated

Millions

Millions

Millions


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Meanwhile, there has also been amazing progress on the second major goal or the AIDScommunity: scaling up treatment. Tis is due mostly to the Global Fund to Fight AIDS,uberculosis and Malaria, and to a U.S. program called PEPFAR: the United States PresidentsEmergency Plan or AIDS Relie. More than 6.6 million people are alive today because they aretaking ARV drugs. en years ago it looked as i almost all o these people would die because the

drugs were available only in rich countries.Between 2008 and 2010 the Global Fund gave $8 billion or AIDS (57 percent), malaria (29percent), and tuberculosis (14 percent). Other than PEPFAR or AIDS, the Global Fund is thebiggest donor or all three o these diseases. It provided the money or 230 million bednets,which have been key to the 20 percent decline in malaria deaths over the past decade. It alsoprovided treatment or 8.6 million cases o tuberculosis. I am not doing a section on malaria orB in this years letter, but there has been good progress in both diseases, with the Global Fundbeing key to this.

Te Global Fund does a lot to make sure its money is spent efficiently. Given the places wherethe Global Fund works, it is not surprising that some o the money was diverted or corruptpurposes. However, the Global Fund ound these problems itsel and changed the way it handled

training grants, where most o the problems were. Unortunately, news o any corruption makesmany citizens think the entire program is mismanaged and a huge portion o the money is beingwasted. Some o the headlines that talked about two-thirds o specific grants being misdirectedueled this impression. In act, less than 5 percent o Global Fund money was misused, and withthe new procedures in place that percentage will be even lower. Our oundation is the biggestnongovernment supporter o the Global Fund, committing $650 million over the years becauseo the incredible impact its spending has. I am confident that this is one o the most effectiveways we invest our money every year, and I always urge other unders to join us in getting somuch bang or our buck.

Between 2011 and 2013, assuming that all donors honor their commitments, the Global Fundwill disburse $10 billion. Tis is a $2 billion increase, but not nearly the $12$14 billion that is

needed and was hoped or. Citizens o donor countries should know about the difference theirgenerosity has made. Te cost o keeping a patient on AIDS drugs has been coming down, andit looks like getting it to $300 per patient per year should be achievable. Tat will mean every$300 that governments invest in the Global Fund will put another person on treatment or ayear. Every $300 thats not orthcoming will represent a person taken off treatment. Tats a veryclear choice. I believe that i people understood the choice, they would ask their government tosave more lives.

Family Planning

Melinda has ocused a lot o her oundation timeon amily health issues, includingmaternal and inant health, nutrition, and amily planning. In 2012 and beyond, she will really

emphasize amily planninggiving women the tools they need to plan how many children theyhave and when they have them. She will be talking much more about how having the ability toplan changes the lives o women and their amilies and improves whole societies. Last year,Melinda met with mothers in Korogocho, a slum outside o Nairobi, Kenya. She was touched byone woman who explained why she wanted to be able to space her births urther apart: I wantto bring every good thing to one child beore I have another.

One amazing thing is that parents desire to bring every good thing to their children can have ahuge impact on national economies. Melinda spoke at the World Bank about how developingcountries have a chance to benefit rom something called the demographic dividend. Te ideais that as parents bring their amily size down, countries can invest more in educating youngpeople. When those young people reach working age, they boost productivity and economic

growth. South Korea and Tailand are two recent examples o how countries that understandand capitalize on these principles can rapidly transorm their economies.

Over the next 40 years, the global population is projected to grow at just .8 percent per year. Itjust passed 7 billion and will reach 9.3billion by 2050, according to the United Nations mediumestimate. However, the populations o most poor countries, which have the hardest time eedingand educating their citizens, will more than double between now and 2050. I we compare



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Melinda meets with a mothers group in the Korogocho slum (Nairobi, Kenya, 2011).

Nine Countries with HighPopulation Growth Rates

COUNTRY

2011POPULATION(in thousands)

2050PROJECTION

(in thousands)PERCENTCHANGE

Afghanistan 32,000 77,000 136%

Democratic Republic of the Congo 68,000 149,000 120%

Ethiopia 85,000 147,000 73%

India 1,250,000 1,736,000 39%

Niger 16,000 56,000 246%

Nigeria 163,000 392,000 140%

Pakistan 178,000 279,000 57%

Uganda 35,000 95,000 173%

Yemen 25,000 62,000 149%

Source:United Nations, Department of Economic and Social Affairs, Population Division (2011).


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population by continent now and in 2050, we see that Arica will more than double in population(rom 1 billion to 2.2 billion) while Asia and the Americas will grow by 25 percent and Europewill hardly grow at all!

Looking at the numbers at the country level gives an even starker picture. o take just oneexample, Nigeria, which has the biggest population in Arica, will grow rom 163 million to 392

millionan increase o 140 percent. Tis will likely make the lives o people in that very poorcountry even more difficult.

Melinda and I believe, though, that i the right steps are takennot just helping women plantheir amilies but also investing in reducing child mortality and increasing nutritionpopulationsin countries like Nigeria will grow significantly less than projected. Almost all the oundationsglobal programs ocus on goals that will help with this.

Globally, more than 200 million women say they dont want to have a child within the next twoyears but arent using contraceptives. I amilies that wanted to wait a longer period between birthsor have ewer children had access to the right tools, two things would happen. First, those amilieswould have an easier time acing the challenges o poverty. Second, as national population growth

rates came down gradually, governments would be able to better meet the needs o all their people.A significant number o women indicate that they would use modern amily planning tools ithey were available. Unortunately, the unding to buy these tools, to make them cheaper, and toprovide high-quality inormation to poor amilies has been lacking.

Te tools that are likely to have the highest adoption rates in sub-Saharan Arica are implants orinjectables, not the oral contraceptives that are popular in the United States. Indonesia has madeimplants broadly available, and more than 1.7 million women are using implants today. Teoundation has helped und quality assurance or a lower-cost implant, Sinoplant II, which isregistered today in more than 17 countries and costs 60 percent less than the alternatives. Wealso think that injections can be made cheaper and longer lasting and put into a ormat thatwomen can administer themselves. Tere are a large number o steps required to get new tools

not only approved and manuactured but also understood so that women can make inormedchoices about contraception. Our goal is that every woman should have the ability to choosewhen she wants to have children. Te result will be healthier mothers and children and moreprosperous nations.

U.S. Education

Our work in U.S. education ocuses on two related goals:making sure that all studentsgraduate rom high school ready to succeed in college and that young adults who want to get a

postsecondary degree have a way to do so.On the K-12 side, our top priority is helping schools implement a personnel system that improvesthe effectiveness o teaching, because research shows that effective teaching is the most importantin-school actor in student achievement. Tere are a lot o great teachers in public schools, anda lot o teachers who want to be great but dont have the tools they need. I we could make theaverage teacher as good as the best teachers, the benefit to students would be phenomenal.

A personnel system includes hiring; giving specific eedback; helping employees improve; andcreating pay schedules, benefit plans, and termination procedures. Tere is consensus that thecurrent personnel system in public schools doesnt work. Every element o todays system iscriticized. However, there isnt a strong consensus on what to change. Many states are movingaway rom guaranteed tenure with pay based solely on seniority and what degrees you have. But

most o the alternative measures do not include much investment in teacher evaluation, whichmakes them very dependent on how good the principal is and how well student test scoresmeasure teaching effectiveness.

I still find it hard to believe that 95 percent o teachers are not given specific eedback about howto improve. Even more important than a pay schedule that rewards excellence is identiying andunderstanding excellence so that teachers know how they can improve. In all the meetings Ihave had with teachers around the country, and in the surveys we have done, it is clear that most



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Clockwise from top:Students at Thomas JeffersonHigh School conduct an experiment in a chemistry lab(Tampa, FL, 2011); A teacher works with her student in a

school thats partnering with Khan Academy (Los Altos,CA, 2011); Anita Long teaches pre-algebra at RidgewayMiddle School (Memphis, TN, 2010).

KhanAcademy


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teachers want more eedback and will use it to improve, even i the financial rewards orperormance are comparatively modest.

Te most compelling example I have seen that this concept can work in a way that is great orboth teachers and students is the school district o ampa, Florida that Melinda and I visited thispast all. A key element o the agreement between the teachers union and the superintendent

was to assign 2 percent o the teachers to become peer evaluators. Tese teachers were trained toobserve classroom teaching and provide eedback on 22 different components. Te principalshave also been trained in this approach. Every teacher gets in-depth eedback rom both theprincipal and the peer evaluator.

ampa has been doing this or three years now, and it is already making a big difference. eacherstold us they value having eedback rom two different sourcesthe principal who knows theschool the best and the peer who knows the challenges o their specific job. Te first round oevaluation revealed that many teachers need help engaging the students to prompt criticalthinking and problem solving. Te district started to organize its proessional developmentaround these findings, and the teachers have seized that opportunity to become more effectivein the classroom.

When Melinda and I met with students, they told us that they had seen a big change during theirtime at the school. Te success here required great work by Superintendent Mary Ellen Elia,Classroom eachers Association President Jean Clements, and all o the teachers. I was particu-larly impressed with the peer evaluators. Tey all said they understood great teaching ar better,having done the peer evaluation job. Some o the peer evaluators will go back to teaching andothers will go into schools o education to help make sure new teachers have better preparation.

Afer seeing how valuable peer evaluation is, I think it should be part o every public schoolpersonnel system. Dedicating 2 percent o teachers to do this work is a large investment. It canmean raising the average class size by 2 percent or spending 2 percent more money. With budgetsas tight as they are, most states will not add extra money or evaluation so we will have to makethe case that it is worth the small increase in class size (o ewer than one student per class onaverage). Without this investment I dont think an evaluation system will get enough credibilitywith the teachers or provide enough specific eedback to help teachers improve. Looking at testscores is also valuable or most subjects, but test score data mostly just identifies who issucceedingit doesnt show a teacher what needs to change. I see the willingness to make thisinvestment as a test o whether people are serious about an evaluation system that really works.

Accelerating the development, discovery, and use o innovative educational technologies isanother high priority or us. We have seen a tremendous amount o progress in this area recently,but it is really just the beginning. More needs to be done to equip teachers with the tools andinormation they need to make learning more personalized and engaging.

Social networking is one o the most promising areas, because it helps teachers and students

connect in ways that naturally augment whats going on in the classroom. Services that use socialnetworking, like Edmodo, are really starting to take off because teachers can manage all aspectso the classroom using a platorm with which most people are comortable.

Im also excited to see more and more schools flip the classroom so that passive activities likelectures are done outside o class and in-class time is used or more collaborative and personalinteractions between students and teachers. Khan Academy is a great example o a ree resourcethat any teacher can use to take ull advantage o class time and make sure all students advanceat their own pace.

Great work is also being done by companies that are thinking beyond simply digitizing textbooks.CK-12 Foundation, Udemy, and Ednovo have great teacher- and communitygenerated content.A simple example o how powerul the community can be in this area is eachersPayeachers, a

marketplace that acilitates the sharing and exchanging o lesson plans and other materialsdeveloped by teachers themselves.

Were also just starting to see how impactul gaming can be in an educational context. MangaHighand Grockit are successully delivering un, competitive, game-based lessons that drive greaterengagement and understanding. Zoran Popovi, at University o Washingtons Center or GameScience, is taking this even urther through some amazing work creating games that automaticallyadapt to each students unique needs based on their interactions with the computer.



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Top:Warren, Melinda, Azim Premji, and I talkabout philanthropy (Delhi, India, 2011).

Bottom:Jeff Raikes gives polio drops(Kebbi, Nigeria, 2011).


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Many o these new tools and services have the added benefit o providing amazing visibility intohow each individual student is progressing, and generating lots o useul data that teachers canuse to improve their own effectiveness.

But how do most teachers figure out whats available and right or them? Teres not yet a goodanswer to this question. Good technologies remain unused, and teachers spend too much o

their own time and money. Tats why Im launching a project this year to build an online servicethat helps educators easily discover and learn how to use these new tools and resources. I thinktheres no limit to what a teacher with the right tools and inormation can do.

Foundation Updates

Jeff Raikes continues to do a great job leading the oundation as CEO.achi Yamada,who ran our Global Health program, and Sylvia Mathews, who ran Global Development, moved onto other jobs, and we thank them or their great contributions. Jeff recruited revor Mundel to

run Global Health and Chris Elias to run Global Development. We are very excited about theexperience and talent they bring to the oundation. Our third group, the U.S. Program, whichocuses primarily on our U.S. education work, continues to be ably run by Allan Golston.

In June the oundation moved to a new campus. Te campus is designed to acilitate collaboration,including space or meetings with lots o partners on key oundation topics. Melinda workedclosely with the architecture firm NBBJ to mold the design to fit our work. Already our employeesare seeing the benefit o being in one location where they can collaborate with each other moreeasily, and they say they really value being able to convene grantees and other partners on site.

My ather, William Gates, co-chair along with Melinda and me, continues to provide inspirationand guidance or a lot o our work. In June, he gave a speech to 10,000 Lions Club members whogathered in Seattle or their annual convention. Te streets were closed or their parade, and

then my dad spoke about the Lions impressive work fighting measles. en years ago, 2,000people died rom measles every day. Now, that number is down to 500. My ather, who hasalways encouraged me, loved encouraging an arena ull o people to keep saving childrens lives.

Giving Pledge

Te Giving Pledge, which entails wealthy individuals and amiliesmaking a simplepledge to give away a majority o their wealth during their lietime or in their will, has alreadygrown to 69 people, which is more than we expected when we started. As we began 2011, weheard rom several people who said they plan to take the pledge very soon. Were hopeul thatmany others will ollow. Its inspiring to read peoples rationale or making the pledge; you canfind their letters at www.givingpledge.org.

We brought the group o pledgers together in May or the first o what will be an annual gatheringto learn rom each other. Te event was a great success. A lot o people ound they had goals incommon, so even as the Giving Pledge celebrates the diversity o giving, it has helped spurcollaboration. Were starting to see the ruits o that effort, as members o the group are nowlooking at co-unding projects.

When Warren Buffett, Melinda, and I were in India in March, we sat down with around 60wealthy amilies to hear rom them about Indian philanthropy and share our experiences. AzimPremji, one o the pioneers o philanthropy in India, joined us or the panel discussion. Warrensenergy and humor were in strong evidence. When talking about whether it would be better orthe wealthy to use their money to create jobs, Warren noted that even Santa Claus creates jobs

by employing the elves and reindeer!One thing that really struck me in both the Giving Pledge meeting and the India get-together isthat a key actor holding people back rom being even more generous is finding philanthropicendeavors that make them eel like they are having a significant and unique impact. It has methinking a lot harder about how we can use the web to make it easier or givers o all sizes toconnect to causes and see the results o their giving.



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My dad speaks to the construction team during an openingcelebration of our new campus (Seattle, WA, 2011).


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Why Im Optimistic

Early in 2011, President Sarkozy o Franceinvited meto write a report or the G20 and present it in person at theirNovember meeting in Cannes. Tis was a huge honor, since it isthe first time a philanthropist has been asked to speak to thisgroup. Te organizers werent even sure what country to put onmy badge since I wasnt coming as part o the U.S. officialdelegation. Tey decided to put Invitee on my badge, makingme briefly the head o government o Invitee!

My report ocused on how the G20 can help ensure that the poorestare not orgotten, as rich countries deal with significant economicand budget challenges. Te report, Innovation with Impact:Financing 21st Century Development, is on gatesoundation.org.It starts by describing how much lie has improved or the poorestover the past 50 years. Part o the reason is the aid contributed byrich countries. A lot o media attention ocused on my suggestionso a modest financial transaction tax, increased tobacco taxes, and a carbon tax to support aidcommitments. None o these ideas has universal agreement, and none will solve the problem alone,but they can make a big difference i even just a ew countries adopt them.

Overall, however, I tried in the report to paint a picture o the incredible diversity o resourcesavailable or development. Its not just rich countries giving aid that are having an impact. Idescribed what poor countries themselves are doing to speed their own development; I pointedout how rapidly growing countries like Brazil, China, and India are bringing new experienceand expertise to development; and I discussed some ways in which the private sector can getinvolved in improving the lives o the poor and helping countries develop. I am excited becauseinnovative partnerships that capitalize on the comparative advantages o all these players canaccelerate progress, speeding the transition beyond aid or many poor countries.

Te G20 conerence itsel was a microcosm o the challenges that leaders ace, with the Eurozonecrisis taking a lot o their time. I was impressed that the leaders took 90 minutes to discuss myreport and related issues, and I hope they will set aside time or development when they meet inMexico or next years summit.

Following my presentation, a number o the leaders shared specific suggestions or addressingthese issues. David Cameron said it would make his countrys leadership on giving .7 percent ogross domestic product by 2013 in tough times easier i more countries would do the same. I gotthe strong impression that the leaders themselves are very sympathetic to the case that aidbudgets should not be cut even as governments reduce their spending. However, this will bepossible only i their constituents understand that aid, which is less than 1 percent o the budget

in most countries, has a significant impact on peoples lives. I have tried in this letter to makethat case. Whether its fighting plant disease, treating people with AIDS, or getting a measlesvaccine to a child in a remote areamodest investments in the poorest make a huge difference.

Unortunately, many people believe the oppositethat money spent on development is wasted,or that it doesnt get lasting results. Melinda and I will spend a lot o time in the coming yearexplaining why theyre mistaken. Te relatively small amount o money invested in developmenthas changed the uture prospects o billions o peopleand it can do the same or billions morei we make the choice to continue investing in innovation. We will repeat that message over andover in our speeches and interviews, and on gatesoundation.org and gatesnotes.com, becausewe are convinced that when people hear stories o the lives theyve helped to improve, they wantto do more, not less.

Bill GatesCo-Chair, Bill & Melinda Gates FoundationJanuary 2012

Speaking with French president Nicolas Sarkozybefore a plenary session of the G20 Summit(Cannes, France, 2011).

AP,

CharlesDharapak



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bill gates annual letter 2012

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