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I just traveled halfway around the world to look at a toilet.

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A Very Good Year

Good news you might have missed in 2013

Looking back at 2013, I wanted to share a different kind of list.


You’re probably seeing a lot of people’s year-end lists right now, going through the best movies, books, YouTube clips, grumpy cat memes, etc.

I thought I would share a different kind of list: some of the good news you might have missed. I’ve limited my list to global health and development, where Melinda and I spend a lot of time, but even so, there’s a lot to report. If you measure progress by the number of children who die of preventable causes, or by the number of people who escape extreme poverty—as I do—then 2013 was definitely a good year.

For example:

We got smarter and faster at fighting polio. You may have heard about recent polio outbreaks in Syria, Kenya, and Somalia. What you may not know is just how rapid and effective the response has been. It looks like the outbreak in the Horn of Africa was controlled in 4 months, less than half the time it took to control an outbreak there in 2005. That speed is due in part to the work done at the Global Vaccine Summit held inAbu Dhabi this year. In the past, the world has had to make tough trade-offs between responding to outbreaks, improving routine immunization, and fighting the disease in the last three countries where polio is still circulating (Afghanistan, Pakistan, and Nigeria). There was no coordinated plan or long-term funding for doing all three at once. At the summit the world got both. We adopted a comprehensive plan for pursuing all three goals, including making the world polio-free by 2018. And more than 30 donors—including a number of very generous private individuals—backed the plan with a total of $4 billion in long-term funding. That means we won’t have to make those trade-offs anymore. It’s a huge step forward.

There’s also great news from India. In early 2014, India will have gone three years without a single polio case (assuming no new ones are reported between now and then). That’s a testament to the fantastic job they’ve done immunizing every child, even in the most remote parts of the country. Now they’re focused on keeping the disease from coming back.

Next door, in Pakistan, the political leaders are clearly resolved to get polio out of the country once and for all. When I met Prime Minister Nawaz Sharif this fall, he made it clear that he sees vaccinating children as a matter of justice. Despite the ongoing violence there and in Afghanistan—including horrifying reprisals against vaccine workers—the next couple of years are a good opportunity for us to make progress on this goal.

Child mortality went down—again. One of the yearly reports I keep an eye out for is “Levels and Trends in Child Mortality.” The title doesn’t sound especially uplifting, but the 2013 report shows amazing progress—for example, half as many children died in 2012 as in 1990. That’s the biggest decline ever recorded. And hardly anyone knows about it! If you want to learn more—and I’d urge you to—the report has a good at-a-glance summary on page 3.

The poverty rate went down—again. If you want to read just one article that explains the state of the world’s poor and the future of the fight against poverty, check out “Not Always With Us,” which the EconomistEconomist ran in June. It gives a short but thorough overview of the progress so far—the poverty rate has dropped by half since 1990—and the prospects for keeping it going. As the article says, the biggest factor in reducing poverty over the past few decades has been economic growth—growth that touches not just those who are already rich, but a broad range of people. We’ll need to maintain this growth in the coming decades to keep the poverty numbers coming down. That’s one reason I argue for stepping up our investments on health: Health may not cause growth directly, but it does help lay the foundation for it. I never miss an issue of the , and this might be the best piece they ran this year.

Rich countries re-committed to saving lives. Just this month, donors met in Washington, D.C., to renew their funding commitments to the Global Fund to Fight AIDS, TB, and Malaria. I was there and I got to meet Connie Mudenda, a Zambian woman living with HIV who started getting treatment in 2004 thanks to the Global Fund. The medicine she takes costs just 40 cents a day, and it helped her get healthy, go back to work, and support her family. Connie says that a decade ago, she’d often see people who were so sick with AIDS that they couldn’t even walk. A family member would push them down the street in a wheelbarrow. Today, though, 80 percent of Zambians with HIV have access to treatment, the country’s economy is growing, and Connie says the wheelbarrows have vanished.

There’s a terrible Catch-22 in global health: You need new tools to fight diseases, but if you can’t pay to deliver them, they don’t get made; and if they don’t get made, then no one gives money to deliver them. So it’s fantastic that donors are stepping up to avoid this problem by making big commitments to the Global Fund. Here’s a handy infographic that shows what a massive impact the Fund has had.

A fantastic Web site got launched. If you love data, and if you’re curious about what causes the most suffering around the world, you should check out the Global Burden of Disease Web site, which was launched early this year. (The foundation helped pay for it.) Personally I am a yes on both categories, which is why I have spent a lot of time on there. It lets you make beautiful charts that help you understand the impact of disease in different countries and even see how things change over time.

On a personal note, I should say how grateful I am to everyone who made time to meet with me, from world leaders to health workers in India, Nigeria, Pakistan, and around the globe. Some of these workers take great risks to help people, facing attacks from extremists in order to vaccinate children. They are true global-health heroes.

What’s Ahead in 2014

Next year I’m excited about the continued rollout of a vaccine called pentavalent (because it prevents five diseases). Next year it will be available in South Sudan, the last of the 73 poorest countries to introduce it. India just announced that they’ll start giving it to every child in the nation in 2014. If other countries follow India’s example, pentavalent could prevent 7 million deaths by 2020. Next up are new vaccines to prevent pneumonia and rotavirus (which causes diarrhea). And we’re seeing more middle-income countries like China and India develop the ability to manufacture vaccines, which drives the cost down.

Crucial to delivering all these vaccines is GAVI, an alliance that has helped 440 million children get immunized since 2000. (Go back and read that again: 440 million.) Next year GAVI will be asking donors to renew their commitments, just as the Global Fund did this year. It will be a challenge to raise more money, but I know from experience that people want to help kids get vaccinated when they see what a phenomenal impact it has. It’s hard to resist the thrill of helping to save the life of a single child, let alone millions.

One last note about 2014: I’ll be publishing my sixth annual letter in January. This time I’m planning to take a slightly different tack from years past—Melinda and I will be tackling some of the biggest myths we encounter in our work on health and poverty. It should be a fun one to write. If you’d like to get an e-mail notice when the letter is out, you can sign up here.