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Our 2019 Annual Letter

We didn’t see this coming

Our 2019 Annual Letter
BY BILL & MELINDA GATES

How would you describe 2018?

Was it what you expected?

We’d probably say no. From especially devastating natural disasters on the one hand to record numbers of women campaigning for office on the other, 2018 felt to us like a series of surprises. The world looking backward from today is very different from what we pictured a couple years ago looking forward.

A benefit of surprises is that they’re often a prod to action. It can gnaw at people to realize that the realities of the world don’t match their expectations for it. Some surprises help people see that the status quo needs to change. Some surprises underscore that transformation is happening already.

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Twenty-five years ago, we read an article that said hundreds of thousands of kids in poor countries were dying from diarrhea. That surprise helped crystallize our values. We believe in a world where innovation is for everyone—where no child dies from a disease it’s possible to prevent. But what we saw was a world still shaped by inequity.

That discovery was one of the most important steps in our journey to philanthropy. We were surprised, then we were outraged, then we were activated.

There have been good surprises, too. When we first started learning about malaria, we thought the world would never make real headway on the disease until someone invented a long-acting vaccine. But thanks to bed nets and other measures, malaria deaths are down 42 percent since 2000.

In this year’s annual letter, we’re highlighting nine more things that have surprised us along this journey. Some worry us. Others inspire us. All of them are prodding us to action. We hope they do the same for you, because that’s how the world gets better.

The
Toughest
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We GetBill and Melinda Gates
Our 2019 Annual Letter
February 12, 2019
Bill and Melinda Gates
al2018BGChapterMenuHolder
Annual Letter 2018
We didn’t see this coming |
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Surprise #1
Africa is the youngest continent
SURPRISE #1
Africa is the youngest continent.
Its median age is the lowest in the world.
Bill: The world keeps getting older, but Africa stays (nearly) the same age. It sounds confusing, but it makes sense when you break it down.

The global median age is on the rise. In every part of the world, people are living longer. As more children survive to adulthood, women are having fewer kids than ever before. The result is a global population that’s creeping slowly toward middle age.

Except in Africa. The median age there is just 18. In North America, it is 35. And the number of young Africans is expected to rise in the decades to come.

There are a lot of reasons for this. One is that the annual number of births is going up in the poorest parts of sub-Saharan Africa, even as it goes down in other parts of Africa. This can be either an asset or a source of instability. Melinda and I believe that the right investments will unlock the continent’s enormous potential. Young Africans will shape the future of not only their own communities but the entire world.

Melinda: When economists describe the conditions under which countries prosper, one of the factors they stress is “human capital,” which is another way of saying that the future depends on young people’s access to high-quality health and education services. Health and education are the twin engines of economic growth.
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If sub-Saharan Africa commits to investing in its young people, the region could double its share of the global labor force by 2050, unlocking a better life for hundreds of millions of people.

Girls’ education, especially, is among the most powerful forces on the planet. Educated girls are healthier. They are wealthier. (If all girls received 12 years of high-quality education, women’s lifetime earnings would increase by as much as $30 trillion, which is bigger than the entire U.S. economy.) And their families benefit, too. The more education a woman has, the better equipped she is to raise healthy children. In fact, UNESCO estimates that if all women in low- and middle-income countries finished secondary school, child mortality in those countries would fall by about half.

toilet Elementary student, Solwezi Distict, Zambia

A healthy, educated, and empowered African youth boom that lifts girls instead of leaving them behind would be the best indicator of progress I can imagine.

Surprise #2
Not only can DNA help find serial killers, they can also help prevent premature birth
SURPRISE #2
At-home DNA tests can find serial killers—and could also help prevent premature birth.
Scientists have discovered a potential link between preterm labor and certain genes.
Bill: When police used genetic test results to catch the Golden State Killer last year, the story made headlines around the world. But it’s not the only discovery to come out of at-home DNA tests. By looking at more than 40,000 samples voluntarily submitted by 23andMe users, scientists discovered a potential link between preterm labor and six genes—including one that regulates how the body uses a mineral called selenium.

Some people have a gene that prevents them from processing selenium properly. The 23andMe study (which our foundation helped fund) found that expectant mothers who carry that gene were more likely to give birth early. This suggests that selenium plays a role in determining when a woman begins labor.

Understanding what causes prematurity is hugely important. Fifteen million babies are born premature every year, making it the leading cause of death in children under age five. Preterm birth affects mothers in every part of the world—although some groups experience it at a higher rate (which Melinda will talk about), and premature babies in low-income countries are much more likely to die than ones in richer countries.

Researchers won’t know until later this year how exactly the mineral affects preterm birth risk. But if the link proves substantial, selenium could one day be a cheap and easy solution to help women extend their pregnancy to full term.

This connection is one of several breakthroughs we’ve made in recent years. Better tools and more data sharing mean that we’re finally starting to understand what causes babies to be born early—and what we can do to keep them in the womb longer. I’m particularly excited by the simple blood test for prematurity being developed by a team at Stanford. It can tell a woman how soon she’ll give birth, so she can work with her doctor to minimize risks.

Melinda: Despite all the promising discoveries Bill just described, what’s just as amazing to me is how little we know about prematurity. I can’t think of anything else that affects 10 percent of people in every part of the world but gets so little attention.
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For the vast majority of preterm births, we can’t identify the cause, nor do we know why some groups of women are more prone to delivering their babies early. For example, it’s a mystery why taller women have longer pregnancies. And in the U.S., it’s a mystery why African-American women deliver prematurely more often than women who emigrate here from African countries. One theory is sociocultural—that the racism and discrimination African-American women have faced their whole lives leads to stress that damages their health. Another is that the mix of micro-organisms in women’s bodies may be different when they are raised here. We just don’t know.

Image

But here’s one thing we do know: Prematurity is not binary. It matters a lot how early a baby is born; a baby born at 36 weeks is much better off than a baby born at 34 weeks. Our goal should not be to prevent prematurity categorically, which may be impossible anyway. Instead, it should be to extend pregnancies closer to full term for everyone. And we’re finally starting to fill the gaps in our knowledge about how to do so.

Surprise #3
SURPRISE #3
We will build an entire New York City every month
… for 40 years! The world’s building stock will double by 2060.
Bill: I wish more people fully understood what it will take to stop climate change.

You have probably read about some of the progress on electricity, as renewables get cheaper. But electricity accounts for only a quarter of all the greenhouse gases emitted around the world.

Manufacturing isn’t far behind, at 21 percent. When most people think of manufacturing, they picture widgets on assembly lines, but it also includes the materials used in buildings. Making cement and steel requires lots of energy from fossil fuels, and the processes involved release carbon as a byproduct.

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As the urban population continues to grow in the coming decades, the world’s building stock is expected to double by 2060—the equivalent of adding another New York City monthly between now and then. That’s a lot of cement and steel. We need to find a way to make it all without worsening climate change.

Manufacturing isn’t the only big emitter. Agriculture accounts for 24 percent of greenhouse gases. That includes cattle, which give off methane when they belch and pass gas. (A personal surprise for me: I never thought I’d be writing seriously about bovine flatulence.)

The larger point is that if we’re going to solve climate change, we need to get to near-zero emissions on all the things that drive it—agriculture, electricity, manufacturing, transportation, and buildings. I call these five areas the grand challenges in climate change.

Read our 2019 Annual Letter
Read Bill & Melinda Gates’s full 2019 Annual Letter
Read our 2019 Annual Letter

It’s not realistic to think that people will simply stop using fertilizer, running cargo ships, building offices, or flying airplanes. Nor is it fair to ask developing countries to curtail their growth for the sake of everyone else. For example, for many people in low- and middle-income countries, cattle are an essential source of income and nutrients.

Part of the solution is to invest in innovation in all five sectors so we can do these things without destroying the climate. We need breakthrough inventions in each of the grand challenges.

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I can report some progress. The European Commission recently committed to invest in research and development on the five areas. And the $1 billion private fund I’m involved with, Breakthrough Energy Ventures, is using the five grand challenges to guide all our investments in clean-energy companies. (My BEV work is separate from what our foundation does to help farmers adapt to climate change.)

But we need to do a much better job of informing people about the challenges. It would help if media coverage matched the breadth of the problem. Solar panels are great, but we should be hearing about trucks, cement, and cow farts too.

Surprise #4