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2015 Gates Annual letter Our Big Bet
for the Future
Bill and Melinda Gates

Forty years ago, Bill and his childhood friend Paul Allen bet that software and personal computers would change the way people around the world worked and played. This bet wasn't exactly a wager. It was an opportunity to make computers personal and empower people through the magic of software. Some people thought they were nuts. But the bet turned out well.


Fifteen years ago, the two of us made a similar bet. We started our foundation in 2000 with the idea that by backing innovative work in health and education, we could help dramatically reduce inequity. The progress we've seen so far is very exciting — so exciting that we are doubling down on the bet we made 15 years ago, and picking ambitious goals for what's possible 15 years from now.


Our Big Bet

The lives of people in poor countries will improve faster in the next 15 years than at any other time in history. And their lives will improve more than anyone else's.


Our Big Bet

We see an opportunity and we want to make the most of it.

We're putting our credibility, time, and money behind this bet — and asking others to join us — because we think there has never been a better time to accelerate progress and have a big impact around the world.

Some will say we're irrational to make this bet too. A skeptic would look at the world's problems and conclude that things are only getting worse. And we shouldn't lose sight of the fact that a handful of the worst-off countries will continue to struggle.

Bill and Melinda Gates in Tanzania
When we travel, we meet with people to learn what they need to live a healthy, productive life. Mapinga, Tanzania, 2011

But we think the next 15 years will see major breakthroughs for most people in poor countries. They will be living longer and in better health. They will have unprecedented opportunities to get an education, eat nutritious food, and benefit from mobile banking. These breakthroughs will be driven by innovation in technology — ranging from new vaccines and hardier crops to much cheaper smartphones and tablets — and by innovations that help deliver those things to more people.

The rich world will keep getting exciting new advances too, but the improvements in the lives of the poor will be far more fundamental — the basics of a healthy, productive life. It's great that more people in rich countries will be able to watch movies on super hi-resolution screens. It's even better that more parents in poor countries will know their children aren't going to die.

A quick overview of the bet we’re making about the next 15 years

A quick overview of the bet we’re making about the next 15 years.

It is fair to ask whether the progress we're predicting will be stifled by climate change. The most dramatic problems caused by climate change are more than 15 years away, but the long-term threat is so serious that the world needs to move much more aggressively — right now — to develop energy sources that are cheaper, can deliver on demand, and emit zero carbon dioxide. The next 15 years are a pivotal time when these energy sources need to be developed so they'll be ready to deploy before the effects of climate change become severe. Bill is investing time in this work personally (not through our foundation) and will continue to speak out about it.

We're excited to see how much better the world will be in 15 years. Here are some of the breakthroughs we see coming.

Health — Child deaths will go down, and more diseases will be wiped out

One: Health Child deaths will go down, and more diseases will be wiped out Bill and Melinda Gates


Until recently, the world was split in two.

In one half, virtually all children were vaccinated, had sufficient nutrition, and received proper treatment for common illnesses like diarrhea and pneumonia. The number of children in this half who died before they reached the age of 5 was well under 1 percent.

Then there was the other half.

Here, vaccination coverage was spotty at best, children tended to be malnourished, and standard childhood illnesses went untreated. About 10 percent of these children died before they turned 5; in some countries that percentage was much higher.

In 1990, percent of children who died before age 5 Poor countries 10% Rich countries 1% Source: The World Bank

When we started our foundation, we were looking for the most strategic ways to help equalize the two halves of the world. We thought that if the world put a little more innovation behind saving the lives of poor children — for example, close to the same amount of innovation that goes into making computers faster and smaller — we could make a lot of progress.

When we look at the progress the world has made in the past generation, since 1990, we believe global health equity is an achievable goal. Increased investment in health care has led to better coverage with the vaccines and treatments that were already available, and intensified R&D has led to the development of new vaccines and treatments. The percentage of children who die before age 5 has been cut in half.

The World is Saving Newborns at a Slower Rate than Other Children

5 Ways to Save Newborn Lives for $5 or Less

  • Saving Newborn Lives

    Saving Newborn Lives

    Proven, existing interventions exist. If we could take these to scale, hundreds of thousands more newborn lives could be saved each year.

  • Breastfeeding1

    1. Breastfeeding

    Breastfeeding immediately and exclusively for the first six months gives newborns a 14-times greater chance of survival, providing necessary nutrition and immune protection.

  • Injectable Antibiotics2

    2. Injectable Antibiotics

    Newborns can die very quickly of infection. By empowering healthcare workers to deliver injectable antibiotics immediately when a baby appears ill, we can save 300,000 newborn lives a year.

  • Resuscitation3

    3. Resuscitation

    A hand-pumped oxygen mask and basic training can be critical to saving the life of a newborn struggling to breathe and could prevent one-third of newborn deaths around the time of delivery.

  • Drying + skin-to-skin contact4

    4. Drying + skin-to-skin contact

    Promoting thermal care through skin-to-skin contact can avert 20% of newborn deaths caused by preterm birth complications and is as easy as immediately drying and warming the newborn after delivery.

  • Umbilical Cord Care5

    5. Umbilical Cord Care

    Keeping the umbilical cord clean is essential to prevent deadly infection. Chlorhexidine has been proven to reduce newborn deaths in high mortality settings.

Source: "Newborn health: a revolution in waiting." The Lancet. 20 May 2014

We predict that the next 15 years will see the pace of these developments increase even faster. The world is going to make unprecedented progress in global health.

Here are some achievements that are within the grasp of the “other” half of the world.

Cutting the number of children who die before age 5 in half again. In 1990, one in ten children in the world died before age 5. Today, it's one in 20. By 2030, that number will be one in 40. Almost all countries will include vaccines for diarrhea and pneumonia, two of the biggest killers of children, in their immunization programs. Better sanitation — through simple actions like hand-washing as well as innovations like new toilets designed especially for poor places — will cut the spread of disease dramatically. And we're learning how to help more mothers adopt practices like proper breastfeeding and skin-to-skin contact with their babies that prevent newborns from dying in the first month after they're born. (Newborn deaths have gone down at a slower rate than deaths of older children and now account for almost half of all child deaths.) Many poor countries have built strong health care systems in the past 25 years, and in the next 15 years other countries will pick up on their ideas and provide more care — and higher quality care — for newborns and young children. Ultimately, this will mean millions of people alive and thriving who would have died.

Child Death Under Age 5 is Declining in All Regions

Deaths Per 1,000 Live Births in:

  • Sub-Saharan Africa
  • West and Central Africa
  • Eastern and Southern Africa
  • South Asia
  • Middle East and North Africa
  • East Asia and Pacific
  • Latin America and Caribbean
  • Central Eastern Europe
  • Sub-Saharan Africa
  • West and Central Africa
  • Eastern and Southern Africa
  • South Asia
  • Middle East and North Africa
  • East Asia and Pacific
  • Latin America and Caribbean
  • Central Eastern Europe

Source: UN Inter-agency Group for Child Mortality Estimation

Reducing the number of women who die in childbirth by two thirds. In countries around the world, more and more mothers are giving birth in health care facilities instead of at home. Since 2005, for example, the proportion of mothers delivering at facilities in Rwanda has gone from 31 percent to 72 percent. In Cambodia, it has shot up from 20 percent to 57 percent. By continuing to make sure that the caregivers at those facilities are well-supplied and well-trained, we can take advantage of this global trend and make childbirth much safer for women around the world. In addition, maternal mortality will drop as more women get access to contraceptives and information about spacing their pregnancies safely. As that number goes up, the number of mothers dying will go down.

The last time we cut the child death rate in half, it took 25 years. We will do it again in 15 years.

Graph showing the worldwide percentage of child mortality dropping from nine to 4.6% from 1990 to 2015, then to 2.3% from by 2030 (projected).

Wiping polio and three other diseases off the face of the earth. Destroying a disease utterly is a very difficult thing to do — so difficult, in fact, that it's happened only once in history, when smallpox was eradicated in 1980. But if we keep working hard, we can eradicate four diseases by 2030. We can get polio out of Africa this year and out of every country in the world in the next several years. Guinea worm, an incredibly painful disease whose sufferers spend months incapacitated while worms that can be several feet long burst out of their legs, will also be gone soon, thanks in large part to the leadership of President Jimmy Carter and the Carter Center. We'll also see the last of diseases like elephantiasis, river blindness, and blinding trachoma, which disable tens of millions of people in poor countries. The drugs that can stop these scourges are now being donated in huge numbers by pharmaceutical companies, and they're being used more strategically thanks to advances in digital maps that show where diseases are most prevalent. Last year these free medicines were distributed to 800 million people.

The world will wipe out four diseases by 2030

The world will wipe out four diseases by 2030.

Finding the secret to the destruction of malaria. We won't be able to completely eradicate malaria by 2030, but we will have all the tools we need to do so. These will include a vaccine that prevents people with malaria from spreading it to the mosquitoes that bite them, a single-dose cure that clears the parasite completely out of peoples' bodies, and a diagnostic test that can reveal right away whether a person is infected. Early versions of all these tools are in development now. In 15 years, we'll be poised to send malaria the way of smallpox and polio.

Polio vaccinations in Kebbi state, Nigeria, 2011
Polio vaccination campaigns like this one in Mashakeri village have helped rid Africa almost entirely of the disease.

Forcing HIV to a tipping point. As we make progress toward a vaccine or a cure, the number of people beginning treatment in sub-Saharan Africa will finally outstrip the number of people newly infected. When we reach that point in the region with the most dense HIV transmission in the world, cases will start going down everywhere around the globe for the first time since the disease was discovered more than 30 years ago.

This (partial) list of breakthroughs gives a phenomenal picture of how much progress can be made in just 15 years. Life will get better, faster, because the number of innovations reaching the poor will be greater than ever before.