I’ve been working in global health for two and a half decades now, and the transformation in how we fight HIV/AIDS is one of the most remarkable achievements I’ve witnessed. (It’s second only to how vaccines have saved millions of children's lives.)  

At the dawn of the AIDS epidemic, an HIV diagnosis was often a death sentence. But in the years since, so much has changed. Today, not only do we have anti-retroviral medications that allow people with HIV to live full, healthy lives with undetectable viral loads—meaning they can’t transmit the virus to others. We also have powerful preventative medications known as PrEP, or pre-exposure prophylaxis, that can reduce a person’s risk of contracting the virus by up to 99 percent when taken as prescribed. It’s an incredible feat of science: a pill that virtually prevents HIV contraction.

In theory, if we could get these tools to everyone who needs them and make sure they’re used correctly, we could stop HIV in its tracks. Because when people with the virus receive proper treatment, they can’t transmit it to others. And when people at risk take PrEP, they can’t contract it. In practice, however, getting these tools to people—and making sure they’re used correctly—is the hard part. Especially for PrEP.  

That’s because current preventatives require people to take medication every single day. Miss a dose, and protection drops. It’s like trying to remember to lock your front door 365 times a year—if you mess up once, you’re vulnerable. For many people, the barriers stack up quickly. Some have to walk hours to reach a clinic. Others struggle to store medication safely or discreetly at home. And many face judgment and stigma for taking PrEP, especially young women in conservative communities. The very act of protecting yourself can lead to being shamed or ostracized. 

That’s why I’m so excited about a new wave of innovations in HIV prevention. Scientists are in the process of developing several longer-lasting PrEP breakthroughs, each with distinct advantages that could help more people protect themselves on their own terms. 

Lenacapavir, which requires only two doses per year through injection, could open HIV prevention up to people who can’t make frequent clinic visits. Cabotegravir, another injectable option that works for two months at a time, offers a more flexible dosing schedule than daily PrEP pills, too. Meanwhile, a monthly oral medication called MK-8572, still in the trial stage, could provide an alternative for people who prefer pills to injections. The Gates Foundation is even exploring ways to maintain a person’s protection for six months or longer. And researchers are working on promising PrEP options that include contraception, which would be particularly valuable for women who need both types of protection. 

To understand how these options work in real life, and not just in labs, our foundation has supported implementation studies in South Africa, Malawi, and elsewhere. Unlike traditional clinical trials that test safety and efficacy in highly controlled settings, these studies examine how medications fit into people’s lives and work in everyday circumstances—looking at ease of use, cultural acceptance, and other practical challenges. This real-world understanding is crucial for successful adoption.  

Some people ask me if these new preventative tools mean the Gates Foundation has given up on finding an HIV vaccine. Not at all. In fact, these advances push us to aim even higher in our research for a vaccine that could prevent HIV for a lifetime—and not just a few months at a time. Our goal is to create multiple layers of protection, much like modern cars have seatbelts, airbags, and even collision-warning sensors. Different tools work better for different people in different ways, and we need every tool we can get. 

But even the most brilliant innovations make no difference unless they reach the people who need them most. This is where partnerships become crucial. Through grants to research institutions around the world, the foundation is working to lower manufacturing costs for HIV drugs so they’re accessible to everyone, everywhere. Then there are organizations like the Global Fund and PEPFAR, which have been instrumental in turning scientific advances into real-world impact.  

The Global Fund—which needs to raise significant new resources next year to continue its work—currently helps more than 24 million people access HIV prevention and treatment. And PEPFAR has saved 25 million lives since its inception in 2003—a powerful example of how American leadership can build tremendous goodwill while transforming the world. Motivated by the belief that no person should die of HIV/AIDS when lifesaving medications are available, President George W. Bush created PEPFAR with strong bipartisan backing and it continues to serve as a lifeline to millions of people.  

We're at a pivotal moment in this fight. Twenty years ago, many believed it would be impossible to deliver HIV treatment at scale in Africa’s poorest regions. Since then, we’ve made fantastic progress. Science has shown us promising paths forward—for better prevention options, easier treatment regimens, and, maybe one day, an effective vaccine. Our task now? Ensuring the life-saving innovations we already have reach the people whose lives they can save. 

I’ve never been much of a soccer fan. (Tennis and pickleball are my favorite sports.) Still, seeing the athleticism and passion on display during the World Cup, I understand why soccer has earned the nickname “the beautiful game.” What makes soccer even more beautiful is the positive impact it can have off the field.

There may be no better example of this than the work of a unique non-profit organization called Grassroot Soccer, which was featured at a health innovation event where I spoke earlier this week.

For the last two decades, Grassroot Soccer has used the incredible popularity of the game to help young people across Africa navigate some of their toughest health challenges.

Despite significant progress in health and development in Africa, including a dramatic decline in child mortality, HIV/AIDS continues to be a leading cause of death among youth in Africa. Sexual violence threatens the health and safety of girls. A lack of access to contraceptives contributes to high rates of teen pregnancy. And mental health services are often unavailable.

Solving these challenges is difficult—and especially important given that 60 percent of Africans are under the age of 25. So, how can soccer make a difference?

Because it’s so popular, soccer offers a hook to capture the attention of young people. Grassroot Soccer uses the game to involve them in activities that encourage them to live healthier, more productive lives.

Here’s one simple example. In an activity called “Risk Field,” players are asked to dribble a soccer ball through cones labeled with some of the risky behaviors that young people often encounter, such as unprotected sex, HIV, multiple partners, and alcohol.

The local youth who serve as Grassroot Soccer coaches are a critical component of the program. Trained in basic counseling skills, the coaches play an important role as trusted mentors to the young participants.

The coaches also accompany adolescents to clinics where they can get HIV testing, contraceptives, and other services. (In some countries, young people might be turned away because of their age or criticized by health staff for seeking contraceptives and testing. The coaches serve as advocates to support their right to health services.) Coaches also conduct home visits to talk with parents and guardians about their programs and health services.

Founded in 2002 by Dr. Tommy Clark, a pediatrician and former professional soccer player, Grassroot Soccer initially focused on stopping the spread of HIV. (The Gates Foundation was an early funder of its work.) Today the organization works in more than 60 countries and has reached more than 18 million young people.

Studies have shown that its participants had better access to sexual and reproductive health services, were more likely to stick with their HIV treatment, and were less likely to experience depression.

That kind of impact gives everyone, even casual soccer fans like me, something to cheer about.

What do humans and cows have in common? Among other things, we’re both victims of tiny insects.

For cows, the latest culprit is the New World screwworm. Despite the name, the screwworm is actually a type of fly that likes to lay its eggs on animals like cows, which creates an often-fatal wound on the animal’s hide. Screwworms once killed up to one million cattle a year here in the United States, and sixty years after we eliminated them in our country, they’re back.

For humans, one of our greatest nemesis is the mosquito. There are plenty of reasons to hate mosquitoes, but malaria is easily at the top of the list. The disease kills more than 600,000 people every year, most of them children, and it’s transmitted when a mosquito infected with a parasite called Plasmodium bites you.

Protecting people (or cattle) from an insect poses an interesting challenge. How do you stop something so small from hurting anyone? There are lots of different ways to approach the problem.

One approach is to keep insects out of the places where people are. There are already lots of tools that do this with mosquitoes, with more in the pipeline. The most widely used is the bed net, a gauzy sheet of fabric treated with an insecticide that kills any mosquito that tries to reach the person sleeping under it.

Bed nets are magical. In some places where malaria is endemic in Africa, they’ve reduced the number of children who die before the age of 5 by 20 percent. But there’s a problem: Mosquitoes can develop resistance to the insecticide used in bed nets, just like bacteria can evolve resistance to antibiotics.

Enter the dual active ingredient bed net. (You’ll often see them referred to as dual AI nets, even though they have nothing to do with artificial intelligence.) By treating bed nets with two different insecticides, scientists have been able to figure out how to negate a mosquito’s resistance and keep people safe. The catch is that dual AI nets are more expensive than regular bed nets, which is why the Global Fund and the Gates Foundation stepped in to make them affordable for the countries that needed them most. The results so far have exceeded my expectations. Dual AI nets now make up more than half of the bed nets used, just two years after they became available.

Bed nets have another flaw: They only protect you while you’re under them, even though mosquitoes are also active in the hours before you go to sleep and after you wake up. A new tool called a spatial emanator aims to bridge that gap. It basically works like a plug-in air freshener—but instead of releasing a nice fragrance, it slowly releases an insecticide at a low-enough dose that doesn’t harm people but drives away any mosquito that might enter your home.

When spatial emanators received the green light for use a year ago, they became the first new malaria-prevention tool the WHO has recommended in over a decade. I’m super excited about their ability to protect people from mosquitoes for more hours of the day.

Another approach to stopping insects is to target them at the population level. That’s how the world stopped screwworm the first time. In 1954, scientists figured out a way to use radiation to make the males sterile. They released the neutered insects into the target area, and since they couldn’t reproduce, the population died off. This approach worked sixty years ago, and it still works today (and scientists are working on even more effective methods).

What if we could use a similar approach to stop mosquitoes? Last year, I wrote about an incredible project in Tanzania called Transmission Zero. The idea behind it is simple: a mosquito that can’t give you malaria.

Tanzanian scientists have found a way to make Anopheles gambiae mosquitoes—the species responsible for most of the malaria in Africa—produce two types of molecules, naturally found in frogs and bees, that block the parasite from developing inside the insect. The mosquitoes would continue flying around, doing their mosquito business, but they wouldn’t be able to make anyone sick with malaria. Each time they mated with another mosquito, they would pass on the gene that protected them from the parasite. (I just published a new profile of Dr. Lina Finda from the Ifakara Health Institute in Tanzania, who is helping lead this work.)

These malaria-free mosquitoes could potentially help save tens of thousands of lives every year. And Tanzania isn’t the only country on the cutting edge of advancing this work. The Ugandan Virus Research Institute and the University of Sciences, Techniques and Technologies of Bamako in Mali are also doing pioneering work to move the field forward. Scientists are learning more every day about the role mosquitoes play in ecosystems, and research is now underway on two other species beyond Anopheles gambiae.

Dual AI bed nets, spatial emanators, and malaria-free mosquitoes are just the latest breakthroughs to come out of the robust malaria innovation pipeline. Treatments continue to get better, and vaccines are already proving to save lives, with even more effective next-gen vaccines to come. A lot of interesting work is underway with endectocides, a type of drug that could potentially make your blood toxic to mosquitoes. There’s even a fascinating trial that looks at whether targeting mosquito larvae in rice paddies could make a difference. The goal of this trial is to stop malaria, but early results from Nigeria and Rwanda indicate that larval control could boost rice yields as much as 50 percent, which would be incredible for farmers.

Unfortunately, while the R&D progress we’re making is remarkable, the same can’t be said for the fight against malaria overall. Donor governments are cutting health aid—including money for the Global Fund, which has saved more than 70 million lives to date by helping deliver lifesaving tools like bed nets. Last year, our partners across Africa pulled off a miracle to minimize the impact of the cuts. With support from our foundation, they found creative ways to distribute supplies that were already in warehouses across the continent.

This year, the picture looks different. While some funding has since been restored, cuts from multiple donor governments mean it's not yet enough to guarantee bed nets and other tools reach every family who needs them. Our foundation is doing everything we can to help close that gap. I continue to advocate for increased funding, because it is ridiculous to put the health of the world’s children at risk when we know how to save them.

I believe we can end malaria forever. We have some of the tools we need already, and I think we’ll have the rest soon. We can defeat mosquitoes, just like we stopped screwworm more than half a century ago and just like we’ll stop it again. The question is whether the world will choose to make it happen.

The choice is obvious to me. We have an opportunity to ensure that no child dies from malaria ever again. Let’s take it.

Dr. Lina Finda’s work sounds simple. “My job is to listen,” she says. But the reality is much more complicated. On a typical day, she has to walk into a village in southern Tanzania or a meeting hall in Uganda and gauge reactions to the idea of ending malaria by an unusual method: releasing more mosquitoes.

It’s not as crazy as it seems.

That’s because the mosquitoes she’s talking about in this case carry a gene that blocks the malaria parasite from developing, so the mosquito can’t get you sick even if you get bitten. (I just wrote about the project researching these malaria-free mosquitoes, Transmission Zero, along with the other tools that are helping us fight this disease.) Release enough of them into the wild and, in theory, the trait spreads on its own until the local mosquitoes can no longer transmit the disease.

The science is advancing, and it’s exciting. But none of these malaria-free mosquitoes have been released in Africa yet. Whether that ever happens is a decision that will be made by African governments and the people who live where these mosquitoes would circulate. Finda co-founded the African Conversations Initiative to make sure those people have a say. Her team is now working in eight countries: Tanzania, Kenya, Uganda, Rwanda, Zambia, Ghana, Nigeria, and Senegal.

The question that started it

Finda first learned about the potential of malaria-free mosquitoes in 2017, at the beginning of her PhD in public health.

“My thought was, oh my God, we might eliminate this disease in my lifetime,” she says.

All the scientists in the room with Finda were equally impressed and excited. But she knew this kind of idea would never leave a lab if there wasn’t community trust and buy-in.

So she asked herself a question: “How might other people react to this?” She dedicated the rest of her career to understanding the answer.

Listening and learning

Her first attempts to explain malaria-free mosquitoes went poorly. The process that creates malaria-free mosquitoes is hard to describe, and Finda assumed that a farmer with no formal schooling would never get there. So she gave up on finding the right words and told the truth instead: She didn’t know how to talk about it. “I was honest with the community members and saying, I really don’t know what to call this or how to talk about it.”

The response surprised her.

One of those community members was Aloyce Kimario, a farmer who also teaches at a primary school outside Ifakara. He had never heard of malaria-free mosquitoes before Finda came to see him. He had, however, spent his whole life rearing animals.

The pigs he keeps are a local breed, hardy against the diseases that circulate around Ifakara. But they’re small. When he wants animals big enough to sell well, he crosses them with a heavier breed and hopes the piglets come out with the best traits of both sides. There’s a Swahili phrase for this, kubadilisha mbegu, which translates to “changing the seed.”

So, Finda started asking farmers to describe their ideal animal. One told her he wanted a pig that was 90 percent of the heavy breed and 10 percent of the local one.

“So what this technology does,” she told him, “is it makes sure that you get exactly what you want.”

Aloyce can now explain the science behind malaria-free mosquitoes, and the case for them, without any help from Finda, in terms other farmers immediately understand.

What she wishes scientists understood

Finda admits to underestimating what local farmers would be able to grasp, and she says she sees the science community making the same mistake. Worse, she says, “they assume that when someone opposes something it is because they don’t know it, and if they could know it, then they would definitely accept it.”

“From my years of listening to everyone, I have learned that these groups are quite knowledgeable,” she says. They may not use the scientific terminology, “but they understand it in their context.”

Finda’s team has now sat down with national malaria programs, regulators, scientists, civil society organizations, faith leaders, and youth groups from more than 25 African countries. Each group worries about something the others don’t, and all of the worries are valid.

“You don’t ever hear someone say, I want to develop a solution for this disease. Let me go talk to a priest,” Finda says.

But that’s exactly what Finda did. One of the leaders she convened was the presiding bishop of the Moravian Revival Church in Tanzania, who had learned about genetically modified organisms while studying theology in the UK but had never encountered the idea applied to mosquitoes. He prayed about it and came out in favor. According to Finda, many Muslim leaders she connected with reached a similar conclusion. They just had to be asked.

Making sense of the numbers

Still, Finda has encountered substantial opposition and even anger.

When she presented the latest national malaria mortality figures to a group of community leaders in Nigeria, they took the statistics as an accusation and nearly threw her out. “You are saying that many people have died of malaria in Nigeria. Show us where they are buried,” they demanded. “Why aren’t our hospitals flooded with malaria patients?”

Finda learned a lesson from this that I’ve had to learn and relearn myself: It’s not the scale of lives lost or saved that captures people’s attention. It’s the individual stories.

“The mothers want to talk about the children they lost,” Finda says. “Those numbers do not mean anything at all.”

So now, when she meets with people, she starts by asking about their own experiences. Aloyce, the teacher-farmer, told her he gets malaria roughly twice a year. So do his children, with some episodes landing them in the hospital. The bishop told her his firstborn child died of it.

Finda herself got malaria around the age of six. Her mother was traveling, so it fell to Finda to administer chloroquine, the recommended treatment at the time, to herself and her toddler brother twice a day for seven days, while both of them were vomiting. She shares this experience, too.

The preparation is worth it

Finda thinks we are still at least a decade away from any government decisions to release malaria-free mosquitoes. In the meantime, African-led research will continue to advance scientific understanding that can inform these decisions and those required to strengthen regulatory systems to govern them. Everything she does is working up to that moment, and aimed at making it as anticlimactic as possible.

“When it is released in the newspapers or the radio or TV,” she says, “that should not be the first time that people hear about this technology.”

For many people, because of Finda’s work, it won’t be.

Sometimes when I tell people I’m optimistic about the future, they look at me like I’m crazy. How could I say that when there’s so much violence in the world, the international order seems to be collapsing, and AI may end up doing more harm than good?

I see all these problems too, and I’m deeply concerned about them. (I am working on a long memo about the risks and benefits of AI that I plan to publish later this month.)

But through my work with the Gates Foundation and other organizations, I also get to see signs of progress that help me stay optimistic.

To me, being hopeful about the future doesn’t mean you ignore the bad news. It’s actually the opposite: You look directly at it and then search for people who are doing something about it. In most cases, you’ll find them. And then you will start to see the broader trend of progress they are contributing to.

Here are some of my favorite signs of progress.

IN THE PAST:

• We’ve cut the number of children who die every year by more than half, from more than 9 million in 2000 to fewer than 5 million now.
• For the first time, we have a blood test for Alzheimer’s and drugs that may slow its progress.
• Electric vehicles now make up about one in four new cars sold worldwide, with sales topping 20 million in 2025.
• There are 1.5 billion fewer people living in extreme poverty today than in 1990, even though the population has risen 50 percent since then.
• Nearly 95 million girls have been fully immunized with HPV vaccine, so they’re much less likely to develop cervical cancer later in life.
• More than 86 percent of the world’s adults can read and write, up from about 68 percent in 1979.

IN THE PIPELINE:

• The newest obesity drug in trials produces nearly 30 percent weight loss, almost as good as what surgery achieves. The same class of drugs is expanding fast into related conditions, including sleep apnea, fatty liver disease, and hopefully, osteoarthritis.
• Scientists are developing a single-shot cure for sickle cell disorders, which kill tens of thousands of people every year, and it could be available within five years. The underlying technology is also being used to develop a single-shot HIV cure.
• We’re close to eradicating polio, which is endemic in only two countries. We’re nearly done with Guinea worm disease as well, cutting it from 3.5 million cases in 1986 to just ten last year.
• The mRNA technology behind some COVID vaccines is now being used for cancer vaccines, with nearly 100 in clinical trials for melanoma, lung, pancreatic, and other cancers.
• A new tuberculosis vaccine is in final-stage trials. If it works, it will be the first new TB vaccine in more than a century and could prevent tens of millions of cases over the next 25 years.

I love telling these stories. Here’s a video where you can see the amazing impact of the Green Revolution.

I find that trying to keep a positive attitude is valuable in itself. It keeps me grounded so I don’t swing toward one political extreme or another. I think the world might be less polarized if more people had a sense of the positive things that are going on in addition to the problems we need to solve.

You can find more videos here about progress. If you see one that strikes a chord for you, I’d encourage you to share it.

If you’re anything like me, you have a favorite chart. Mine has been the same for years. It plots under-five mortality year over year—a figure that has dropped by half since the turn of the century, from over 10 million deaths in 2000 to fewer than 5 million in 2023.

In my view, this data is the strongest evidence we have that progress is possible, even in tough times, and that the investments the world has made in vaccines, oral rehydration, bed nets, and better nutrition are working.

But there's a rule in global health statistics that complicates the story: To count as a death, someone must have first been born alive. It sounds simple and obvious. But in practice, it isn't. That's because every year, about 2 million pregnancies end in stillbirth, which is when a baby is lost at 28 weeks or later. That's late enough that the mother has been feeling the fetus move for months. Many parents have already picked out a name. Often, the loss occurs in the final stretch of a pregnancy, or during labor itself, when everyone was expecting a healthy birth.

These tragedies should be central to how we measure child survival. Instead, they've fallen through the cracks—not quite a maternal health issue, not quite a child mortality issue. The UN didn't publish its first full global estimate of stillbirths until 2020, and stillbirth research is still badly underfunded in both rich and poor countries.

What gets measured gets managed, as the saying goes—and what doesn't, well, doesn't.

The data reflects this disparity. Stillbirths have fallen just 34 percent since 2000, compared to 50 percent for under-five mortality over the same period. In 81 countries—mostly low- and middle-income—the stillbirth rate hasn't meaningfully improved at all in 25 years. For every one stillbirth in Europe, there are roughly 40 in sub-Saharan Africa.

What's frustrating is that we know what causes, and therefore how to prevent, most stillbirths. One of the biggest drivers is pre-eclampsia—a dangerous spike in blood pressure during pregnancy—which is responsible for half a million fetal deaths every year, along with 70,000 maternal deaths. Beyond that, the bulk of stillbirths stem from a cluster of conditions we understand well: maternal infections, obstetric complications during labor, and chronic conditions like untreated diabetes.

If we could catch these problems earlier, we'd have a much better chance of intervening before it's too late. But that's hard to do in the rural clinics where most pregnant women receive care, which often have unreliable electricity, no specialists, and little in the way of lab equipment. By the time pre-eclampsia is obvious, or gestational diabetes has gone unmanaged through the third trimester, the harm is often irreversible. Even emergency intervention may not help.

But a few months ago, I got to hold a device that has the potential to make a huge impact: the Remidio fundus camera. You hold it up to a patient's eye to get a high-resolution image of their retina in seconds, no dilation required. A community health worker with a few hours of training can use it. The device itself is about the size of a handheld video camera, battery-powered, and portable enough to carry from village to village.

Why the retina? It's the only place in the body where you can see blood vessels from the outside.

Remidio is a medtech startup out of India, and its camera was originally built to screen for diabetic eye disease. With an AI system running on a phone the camera plugs into, it can pick up early signs of the disease that would otherwise require blood draws and specialist follow-up to catch. It's already been used that way for more than 15 million patients in 40 countries.

But that same hardware, with different software, can also flag the conditions that drive so many dangerous pregnancies. Gestational diabetes sharply increases the risk of pre-eclampsia, preterm birth, and fetal death, and in most of rural sub-Saharan Africa or South Asia, it usually isn't screened for at all, because the standard test requires a lab. A retinal scan offers a different way in. Remidio’s device is currently being used in India to screen pregnant women for conditions that drive stillbirth. And researchers are now adapting the same hardware to screen for anemia and hypertension, too.

A tool like Remidio’s won’t solve the problem of stillbirths alone. We also need more skilled birth attendants, better emergency obstetric care, and stronger health systems. But small, portable, affordable diagnostics in the hands of community health workers are exactly the kind of lever that can start to move a number that hasn't moved in a long time. That's a big part of why the foundation committed $2.5 billion to women's health research and development last year, our largest investment in this area ever.

In 25 years, I hope my favorite chart in the world will have two lines on it: one tracking under-five mortality, and one tracking stillbirths. With the right commitment, I believe both will have fallen dramatically, and both could be approaching zero.

When most Americans think of polio, we probably picture President Franklin Delano Roosevelt. In 1921, at age 39, he was paralyzed by the virus and never regained the use of his legs. His story helped turn polio into a national cause. But in many ways, his experience was an anomaly.

After all, polio is overwhelmingly a childhood disease, with the vast majority of cases affecting those younger than five. That was true when FDR fell ill, and it’s true today. The typical patient isn’t an adult with an already established political career—it’s a little kid, often a little kid in a low-income country, who might never get the chance to take his first steps.

That injustice is one big reason I've spent the past two decades working to eradicate polio. The other reason is that eradication is actually possible, realistic, and well within reach. This is a disease we can get rid of—not just control, but eliminate everywhere. That is a rarity in global health.

The world has already made extraordinary progress. Back in 1988, when Rotary International and the World Health Assembly set the goal of eradication, the virus was paralyzing more than 350,000 children each year across 125 countries. Since then, cases have dropped by 99.9 percent. The strains known as Type 2 and Type 3 wild poliovirus have been eradicated. The entire African continent is certified wild-polio free. Only two countries—Afghanistan and Pakistan—still have persistent transmission of Type 1 wild poliovirus.

Now we're closer than ever to total polio eradication. But the last mile is proving the hardest because viruses find ways to exploit any immunity gaps or weaknesses. Wherever vaccination rates slip—even briefly—they can resurface.

One of the biggest challenges comes from what are called variant outbreaks. In communities where immunization is low, the weakened virus used in the oral polio vaccine can circulate asymptomatically and rarely, over time, mutate enough to regain the ability to cause paralysis in unvaccinated children.

While most variant outbreaks happen in places with extremely low vaccination coverage, poor sanitation, and weaker health systems, no place is risk-free until the world is polio-free. In 2022, the United States confirmed its first paralytic polio case in nearly a decade, and the virus was detected in New York wastewater samples. In the time since, variant polioviruses have also been found in the U.K., Ukraine, Indonesia, and other countries.

The good news is that today’s tools are better than anything we had even five years ago, and they make every dollar spent on the cause go further than ever before. We have a new oral vaccine, nOPV2, that’s far less likely to mutate and lead to new variant outbreaks; nearly two billion doses have already been given worldwide. New regional labs in Ghana, Nigeria, South Africa, and Uganda that test wastewater samples and sequence viruses have cut detection times by over 30 percent, which gives health workers a critical head start on outbreak response. And the surveillance network for polio is one of the most sophisticated ever built—also helping alert public health officials to outbreaks of cholera, measles, Ebola, and even COVID-19 at the height of that pandemic.

The Gates Foundation has been proud to support these advances as part of the Global Polio Eradication Initiative, a coalition of the WHO, UNICEF, the CDC, Gavi, Rotary International, and dozens of countries’ governments. It’s one of the most successful collaborations in the history of global health.

But right now, GPEI is facing a $1.7 billion funding gap, with various long-term donor governments cutting back their support. Without the right resources, vaccination campaigns may have to be scaled back, surveillance sites will likely close, and the virus could spread globally.

In the century since FDR was paralyzed by the virus, American leadership and generosity have helped turn polio into a fight the whole world could win. From the March of Dimes, which funded research, to the development of the first vaccines, to support for eradication campaigns, U.S. commitment has been decisive.

The world is at the brink of ending this terrible disease, and the stakes of this moment couldn’t be higher. If we finish the job, we free up billions of dollars for other health priorities and—most importantly—protect generations of children from a virus that has paralyzed millions. If we back down from the fight, up to 200,000 children could be paralyzed each year within a decade.

We have the scientific tools and infrastructure needed to cross the finish line. And we have hundreds of thousands of committed vaccinators who are determined to get us there—who go door to door across deserts, jungles, floodplains, and war zones to make sure no child is missed. I've met them, I've heard their stories, and I've seen how determined they are to finish the job.

We should be too.

Greetings from the Lone Star State! I’m in Texas this week for the Breakthrough Energy Ventures Investors Summit. This is one of the best places in the world to see the future of energy, and I can’t wait to see how much progress has been made since my last visit.

There’s a lot on the agenda this week, but I’m especially excited to talk about electricity breakthroughs. By 2050, the world will need nearly three times as much power as we use today—and if we’re going to decarbonize the economy, we’ll have to electrify a lot of things that currently use fossil fuels. That means we need to deliver a huge amount of energy in a clean, reliable, and affordable way.

If you’re an electricity nerd like me, this is an exciting moment. Earlier this month, TerraPower—the next-generation nuclear power company I created in 2008—received federal approval to start building the nuclear reactor at its Kemmerer, Wyoming plant. Wind and solar are reportedly generating more electricity than fossil fuels in the EU for the first time. We’re seeing a clear shift as the world’s electricity system is becoming more diverse, more innovative, and more dynamic than ever before.

Here are three of the coolest technologies people will be talking about this week:

Geothermal. Geothermal power has been around for more than a century, but new approaches are unlocking greater potential for the technology. Most geothermal power plants today are located near the boundary between two tectonic plates, where you don’t have to drill as deep to find usable heat that can be pumped to the surface to turn a turbine and generate electricity.

Fervo wants to make geothermal an option in more places by both digging deeper (up to a mind-blowing 15,000 ft below the surface) and extending their wells horizontally at their deepest point. The results so far are super promising: Their pilot project has been consistently generating electricity since 2023, and their Cape Station plant in Utah will come online this year.

Fusion. Fusion is the reaction that powers the sun and stars, and it has the potential to be a virtually unlimited source of clean, safe electricity. Once the technology is fully commercialized within the next decade, it can be built anywhere, scaled up, and used to make huge amounts of electricity with no carbon emissions and minimal waste.

The question right now is how we get there. It seems likely that the first commercial fusion plants will use magnetic fields to harness the reaction to generate electricity. There are two different approaches to this: the tokamak, a donut-shaped machine that is easier to build but harder to keep stable, and the stellarator, a twist-shaped machine that is harder to build but easier to keep stable. (An unstable reaction can damage the machine but poses no risk to safety.) Commonwealth Fusion Systems is on track to turn on their SPARC tokamak next year, and Type One Energy is making great progress with their Infinity One stellarator. Marathon Fusion, Xcimer, and Zap Energy aren’t quite as far along with their approaches, but I’m optimistic about what they’re doing.

Geologic hydrogen. Hydrogen shows great promise as an energy source, and the discovery of geologic hydrogen is one of the biggest energy surprises of the past decade. Although it’s the earliest stage technology on this list, I’m excited about its potential. Geologic hydrogen is a zero-emission power source that is continuously generated underground by the Earth itself. Bourakébougou, a village in Mali, is powered by the small hydrogen field it sits on top of, and researchers have found deposits in the U.S., France, and other places.

This is an unusual technology to talk about because it’s hard to predict a timeline. It could take decades before geologic hydrogen becomes commercially viable at scale—or a company like Koloma or Mantle8 could find a massive deposit tomorrow, and then we’re off to the races. Once we find one really good source, it’ll be much easier to find the second because we’ll know exactly what we’re looking for.

If I could hop in a time machine and see what the future looks like a few decades from now, I would expect to see at least one of these technologies generating a significant chunk of the world’s power. It’s amazing to see so much progress being made in so many different areas, because it means that we’ll have options for how we generate affordable, reliable, clean electricity at the scale the future demands.

When my son, Rory, was younger, we used to love visiting power plants together. It was the perfect father-son activity (for us, anyway), and we always had a blast checking out the huge equipment and learning how it was used to generate electricity.

One of our more memorable trips was to a geothermal power plant that was close to the Þríhnúkagígur volcano in Iceland. I remember looking at the huge plumes of hot steam emerging from the ground and thinking about how amazing it was that people could harness heat thousands of feet below the surface to keep the lights on.

That feeling came back to me earlier this year during a visit to Cape Station, the future home of the world’s largest enhanced geothermal power plant, in Beaver County, Utah.

Few people associate geothermal energy with the United States, and for a good reason: Less than 1 percent of the energy generated in the U.S. is geothermal. A company called Fervo Energy is hoping to change that with an innovative new approach to turning the earth’s heat into power.

Breakthrough Energy and I are proud supporters of Fervo, and it was super cool to see firsthand how much progress has been made at Cape Station. The company’s pilot project in Nevada came online in 2023 with a capacity of 3.5 MW—enough to provide power to about 2,600 homes. Cape Station will be much bigger. Fervo has already drilled 20 of the 24 planned geothermal wells at the facility for Phase I, and the plant is expected to start generating 100 MW of power next year. An additional 400 MW will come online in 2028.

Geothermal is one of the most promising ways to deliver clean energy that’s reliable and affordable.  In order to meet the world’s growing energy needs, we are going to need lots of different ways of making energy. Intermittent power sources like wind and solar will play a key role, but we also need sources of energy that work around the clock without contributing to climate change, like geothermal and nuclear power.

The science behind geothermal energy is pretty simple. The interior of the Earth is incredibly hot, and the deeper you go, the hotter the ground becomes. If you pump fluid deep enough to be warmed by this heat and then pump it back to the surface, you can turn the hot liquid into steam and use it to spin turbines and generate electricity—just like many other types of power plants. 

The reality of harnessing that energy is a lot more difficult. In some places, you only need to go down a few hundred feet to reach the heat you need. In other places, you have to dig down a mile or more. Most wells at Cape Station are between 8,000 and 9,000 feet deep, and the deepest one extends a mind-blowing 15,000 feet below the surface. That is about the depth you'd get to if you stacked 50 Statues of Liberty on top of each other!

Most geothermal power plants today are located near the boundary between two tectonic plates, where you don’t have to drill as deep to find usable heat. That’s why you see them more often in geologically active places like Iceland or California. But Fervo’s approach will make geothermal energy an option in more places.

One of the company’s biggest innovations is the use of horizontal drilling. Instead of just digging straight down, Fervo extends its wells horizontally by as much as 5,000 feet at their deepest point.

This technique is often used by the oil and gas industry to increase contact with a reservoir. The same principle applies to geothermal power. By accessing more heat from the same depth, Fervo’s plants cost less and are viable in more places than traditional geothermal plants. They’re also easier to scale up, which is crucial for meeting the world’s energy needs.

Because these techniques are nearly identical to ones used by the oil and gas industry, Fervo is able to employ workers from that field with minimal retraining. Sixty percent of the company’s employees used to work in oil and gas, including its CEO.

Horizontal drilling isn’t the only thing that sets Fervo’s approach apart. When most people picture a geothermal power plant, they imagine clouds of steam emerging from the ground—like the kind Rory and I saw in Iceland. But if you visit the Cape Station plant when it comes online in 2026, you won’t see any steam at all.

That’s because the plant will use a closed system. Geothermal energy is one of the more climate-friendly sources of power, but one of its downsides is how much water it uses. (All of the steam you see escaping is water lost.) Fervo’s technology captures all the water that would’ve been lost and recirculates it underground to keep the system running.

It’s a truly innovative approach, and I am glad that it is being deployed here in the United States. I was honored to be joined by Senator John Curtis for our tour of Cape Station. We had a great conversation about the role companies like Fervo will play in maintaining America’s energy independence. I told him how great it was to see Utah leading by example—not just on energy innovation friendly policies but on actual deployment.

This is the kind of effort that will help our country remain a leader in energy innovation worldwide. I used to think that geothermal would never be more than 5 percent of the global energy mix. But now I believe it could eventually supply up to 20 percent of the world’s electricity. Geothermal power will have a big role to play in our clean energy future, and it’s exciting to see companies like Fervo push the technology to new depths.

There’s a doomsday view of climate change that goes like this:

In a few decades, cataclysmic climate change will decimate civilization. The evidence is all around us—just look at all the heat waves and storms caused by rising global temperatures. Nothing matters more than limiting the rise in temperature.

Fortunately for all of us, this view is wrong. Although climate change will have serious consequences—particularly for people in the poorest countries—it will not lead to humanity’s demise. People will be able to live and thrive in most places on Earth for the foreseeable future. Emissions projections have gone down, and with the right policies and investments, innovation will allow us to drive emissions down much further.

Unfortunately, the doomsday outlook is causing much of the climate community to focus too much on near-term emissions goals, and it’s diverting resources from the most effective things we should be doing to improve life in a warming world.

It’s not too late to adopt a different view and adjust our strategies for dealing with climate change. Next month’s global climate summit in Brazil, known as COP30, is an excellent place to begin, especially because the summit’s Brazilian leadership is putting climate adaptation and human development high on the agenda.

This is a chance to refocus on the metric that should count even more than emissions and temperature change: improving lives. Our chief goal should be to prevent suffering, particularly for those in the toughest conditions who live in the world’s poorest countries.

Although climate change will hurt poor people more than anyone else, for the vast majority of them it will not be the only or even the biggest threat to their lives and welfare. The biggest problems are poverty and disease, just as they always have been. Understanding this will let us focus our limited resources on interventions that will have the greatest impact for the most vulnerable people.

I know that some climate advocates will disagree with me, call me a hypocrite because of my own carbon footprint (which I fully offset with legitimate carbon credits), or see this as a sneaky way of arguing that we shouldn’t take climate change seriously.

To be clear: Climate change is a very important problem. It needs to be solved, along with other problems like malaria and malnutrition. Every tenth of a degree of heating that we prevent is hugely beneficial because a stable climate makes it easier to improve people’s lives.

I’ve been learning about warming—and investing billions in innovations to reduce it—for over 20 years. I work with scientists and innovators who are committed to preventing a climate disaster and making cheap, reliable clean energy available to everyone. Ten years ago, some of them joined me in creating Breakthrough Energy, an investment platform whose sole purpose is to accelerate clean energy innovation and deployment. We’ve supported more than 150 companies so far, many of which have blossomed into major businesses. We’re helping build a growing ecosystem of thousands of innovators working on every aspect of the problem.

My views on climate change are also informed by my work at the Gates Foundation over the past 25 years. The foundation’s top priority is health and development in poor countries, and we approach climate largely through that lens. This has led us to fund a lot of climate-smart innovations, especially in agriculture, in places where extreme weather is taking the worst toll.

COP30 is taking place at a time when it’s especially important to get the most value out of every dollar spent on helping the poorest. The pool of money available to help them—which was already less than 1 percent of rich countries’ budgets at its highest level—is shrinking as rich countries cut their aid budgets and low-income countries are burdened by debt. Even proven efforts like providing lifesaving vaccines for all the world’s children are not being fully funded. Gavi (the vaccine-buying fund) will have 25 percent less money for the next five years compared to the past five years. We have to think rigorously and numerically about how to put the time and money we do have to the best use.

So I urge everyone at COP30 to ask: How do we make sure aid spending is delivering the greatest possible impact for the most vulnerable people? Is the money designated for climate being spent on the right things?

I believe the answer is no.

Sometimes the world acts as if any effort to fight climate change is as worthwhile as any other. As a result, less-effective projects are diverting money and attention from efforts that will have more impact on the human condition: namely, making it affordable to eliminate all greenhouse gas emissions and reducing extreme poverty with improvements in agriculture and health.

In short, climate change, disease, and poverty are all major problems. We should deal with them in proportion to the suffering they cause. And we should use data to maximize the impact of every action we take.

 I believe that embracing the following three truths will help us do that.

Even if the world takes only moderate action to curb climate change, the current consensus is that by 2100 the Earth’s average temperature will probably be between 2°C and 3°C higher than it was in 1850.

That’s well above the 1.5°C goal that countries committed to at the Paris COP in 2015. In fact, between now and 2040, we are going to fall far short of the world’s climate goals. One reason is that the world’s demand for energy is going up—more than doubling by 2050.

From the standpoint of improving lives, using more energy is a good thing, because it’s so closely correlated with economic growth. This chart shows countries’ energy use and their income. More energy use is a key part of prosperity.

Unfortunately, in this case, what’s good for prosperity is bad for the environment. Although wind and solar have gotten cheaper and better, we don’t yet have all the tools we need to meet the growing demand for energy without increasing carbon emissions.

But we will have the tools we need if we focus on innovation. With the right investments and policies in place, over the next ten years we will have new affordable zero-carbon technologies ready to roll out at scale. Add in the impact of the tools we already have, and by the middle of this century emissions will be lower and the gap between poor countries and rich countries will be greatly reduced.

I wasn’t sure this would be possible when Breakthrough Energy was started in 2015 after the Paris agreement. Since then, the progress of Breakthrough companies and others and the acceleration now being provided by the use of artificial intelligence have made me confident that these advances will be ready to scale.

All countries will be able to construct buildings with low-carbon cement and steel. Almost all new cars will be electric. Farms will be more productive and less destructive, using fertilizer created without generating any emissions. Power grids will deliver clean electricity reliably, and energy costs will go down.

Even with these innovations, though, the cumulative emissions will cause warming and many people will be affected. We’ll see what you might call latitude creep: In North America, for instance, Iowa will start to feel more like Texas. Texas will start to feel more like northern Mexico. Although there will be climate migration, most people in countries near the equator won’t be able to relocate—they will experience more heat waves, stronger storms, and bigger fires. Some outdoor work will need to pause during the hottest hours of the day, and governments will have to invest in cooling centers and better early warning systems for extreme heat and weather events.

Every time governments rebuild, whether it’s homes in Los Angeles or highways in Delhi, they’ll have to build smarter: fire-resistant materials, rooftop sprinklers, better land management to keep flames from spreading, and infrastructure designed to withstand harsh winds and heavy rainfall. It won’t be cheap, but it will be possible in most cases. Unfortunately, this capacity to adapt is not evenly distributed, a subject I will return to below.

So why am I optimistic that innovation will curb climate change? For one thing, because it already has.

You probably know about improvements like better electric vehicles, dramatically cheaper solar and wind power, and batteries to store electricity from renewables. What you may not be aware of is the large impact these advances are having on emissions.

Ten years ago, the International Energy Agency predicted that by 2040, the world would be emitting 50 billion tons of carbon dioxide every year. Now, just a decade later, the IEA’s forecast has dropped to 30 billion, and it’s projecting that 2050 emissions will be even lower.

Read that again: In the past 10 years, we’ve cut projected emissions by more than 40 percent.

This progress is not part of the prevailing view of climate change, but it should be. What made it possible is that the Green Premium—the cost difference between clean and dirty ways of doing something—reached zero or became negative for solar, wind, power storage, and electric vehicles. By and large, they are just as cheap as, or even cheaper than, their fossil fuel counterparts.

Of course, to get to net zero, we need more breakthroughs. This will become even more important if new evidence shows that climate change will be much worse than what the current generation of climate models predicts, because we will need to lower the Green Premium faster and accelerate the transition to a zero-emission economy.

Luckily, humans’ ability to invent is better than it has ever been.

Breakthrough Energy focuses its new investment on the areas of innovation that still have large positive Green Premiums. Below I write about the state of play in the five sectors of the economy that are responsible for all carbon emissions. I’ll cover highlights and challenges—one common theme will be the difficulty of scaling rapidly—and I’ll include some of the companies Breakthrough Energy works with so you can see how much activity there is in each sector.

Electricity (28 percent of global emissions)

Making electricity is the second biggest source of emissions, but it’s arguably the most important: To decarbonize the other sectors, we’ll have to electrify a lot of things that currently use fossil fuels. We need more innovation in renewables, transmission, and other ways to generate and store electricity.

• New approaches to wind power can generate more energy using less land, and advances in geothermal mean it’s being tapped in more places around the world. (Examples: Fervo, Baseload Capital, Airloom)
• Companies are pilot-testing highly efficient power lines that can transmit much more electricity than the previous generation of cables.  (TS Conductor, VEIR)
• We need to keep reducing the cost of clean energy that’s available around the clock, including new nuclear fission and fusion facilities. More than half of today’s emissions from electricity could only be eliminated using these so-called “firm” sources, but they have a Green Premium of well over 50 percent. I’m hopeful that we can get rid of the Green Premium with fission; a next-generation nuclear power plant is under construction in Wyoming. And fusion, which promises to give us an inexhaustible supply of cheap clean electricity, has moved from science fiction to near-commercial. (TerraPower, Commonwealth Fusion Systems, Type One Energy)

Manufacturing (30 percent of global emissions)

When someone tells you they know how to curb emissions, the first question you should ask is: What’s your plan for cement and steel? They’re key to modern life, and they’re hard to decarbonize on a global scale because it’s so cheap to make them with fossil fuels.

• Zero-emissions steel exists today. It’s made using electricity, so if you can get clean electricity that’s cheap enough, you end up with clean steel that’s cheaper than the conventional type. The technology still needs to get into more markets, and companies that make clean steel need to expand their capacity. (Boston Metal, Electra)
• Clean cement faces similar hurdles. Several companies have found ways to make it with no Green Premium, but it takes years to get a foothold in the global market and ramp up manufacturing capacity. (Brimstone, Ecocem, CarbonCure, Terra CO2, Fortera)
• One of the biggest energy surprises of the past decade is the discovery of geologic hydrogen. Eventually, hydrogen will be widely used to make clean fuels and will help with clean steel and cement. Today we make it from fossil fuels or by running electricity through water, but geologic hydrogen is generated by the Earth itself. Companies have already proven that they can find it underground; now the challenge is to extract it efficiently. There’s also been a lot of progress on making hydrogen with electricity much more cheaply than current technology does it. (Koloma, Mantle8, Electric Hydrogen)
• Companies are beginning to roll out ways to either capture carbon from facilities that currently emit it, such as cement and steel plants, or to remove it directly from the air and store it permanently. If captured carbon becomes cheap enough, we could even use it to make things like sustainable aviation fuel. (Heirloom, Graphyte, MissionZero, Deep Sky)

Agriculture (19 percent of global emissions)

Much of the emissions from agriculture comes from just two sources: the production and use of fertilizer, and grazing livestock that release methane.

• Farmers can already buy one replacement for synthetic fertilizer that’s made without any emissions, and another that turns the methane in manure into organic fertilizer. Both are selling at a negative Green Premium. Now the challenge is to produce them in large quantities and persuade farmers to use them. (Pivot Bio, Windfall Bio)
• Additives to cattle feed that keep livestock from producing methane are nearly cheap enough to be economical for farmers, and a vaccine that does the same thing has been shown to work. It’s now moving into the next stage of development. (Rumin8, ArkeaBio)
• Another source of methane is the cultivation of rice, one of the world’s most important staple foods. Companies are helping rice farmers around the world adopt new methods that both reduce methane emissions and increase crop yields. (Rize)
• One stubborn problem is that some of the nitrogen in fertilizer seeps into the atmosphere as nitrous oxide, a potent greenhouse gas. It’s very dilute, which makes it hard to capture.

Transportation (16 percent of global emissions)

Nearly one in four cars sold in 2024 was an EV, and more than 10 percent of all vehicles in the world are electric. In some countries including the U.S., they still have disadvantages, such as long charging times and too few public charging stations, that keep them from being as practical as gas-powered cars. In addition, cars and trucks are just one part of this sector, which also includes tough-to-decarbonize activities like shipping and aviation.

• Airplane emissions are projected to double by 2050, and clean jet fuel still comes with a Green Premium of over 100 percent. Today we know of only two cost-effective ways to make it: produce it with algae, or make synthetic fuel using very cheap hydrogen. Companies are in the early stages of work on both approaches.
• As more transportation goes electric, the demand for batteries is going to increase, which is why companies have developed ways to make them cheaper and more efficient. (KoBold Metals, GeologicAI, Redwood, Stratus Materials)

Buildings (7 percent of global emissions)

Heating and cooling buildings is the smallest slice of global emissions today, but it’s going to skyrocket with urbanization and the growing need for air conditioning.

• Electric heat pumps are widely available, up to five times more efficient than boilers and furnaces, and often the cheaper option. But there aren’t enough skilled workers around the world to install them. Next-generation, extra-efficient heat pumps are already on the market, and ones that are easier to install are in the works. (Dandelion, Blue Frontier, Conduit Tech)
• Other zero Green Premium products are available, including building sealants and super-efficient windows. But as with so many clean technologies, reaching scale takes time. (Aeroseal, Luxwall)

The global temperature doesn’t tell us anything about the quality of people’s lives. If droughts kill your crops, can you still afford food? When there’s an extreme heat wave, can you go somewhere with air conditioning? When a flood causes a disease outbreak, can the local health clinic treat everyone who’s sick?

Quality of life may seem like a vague concept, but it’s not. One useful tool for measuring it is the United Nations’ Human Development Index, which provides a snapshot of how people in a country are faring—from 0 to 1, with higher numbers meaning better outcomes.

If you look through a list of the HDI scores of the world’s countries, the disparities leap out at you. Switzerland has the highest HDI, at 0.96. South Sudan, the lowest, is at 0.33. The 30 countries with the lowest HDI scores are home to one out of every eight people on the planet, but they produce only about one third of 1 percent of global GDP. They have the highest poverty rates and, tragically, the worst health outcomes. A child born in South Sudan is 39 times more likely to die before her fifth birthday than one born in Sweden.

This inequity is the reason our climate strategies need to prioritize human welfare. This may seem obvious—who could be against improving people’s lives?—but sometimes human welfare takes a backseat to lowering emissions, with bad consequences.

For example, a few years ago, the government of one low-income country set out to cut emissions by banning synthetic fertilizers. Farmers’ yields plummeted, there was much less food available, and prices skyrocketed. The country was hit by a crisis because the government valued reducing emissions above other important things.

Sometimes the pressure comes from outsiders. For example, multilateral lenders have been pushed by wealthy shareholders to stop financing fossil fuel projects, with the hope of limiting emissions by leaving oil, gas, and coal in the ground. This pressure has had almost no impact on global emissions, but it has made it harder for low-income countries to get low-interest loans for power plants that would bring reliable electricity to their homes, schools, and health clinics.

Granted, situations like these are complicated, since burning fossil fuels helps people now at the cost of making the climate worse for people in the future. But remember that climate change is not the biggest threat to the lives and livelihoods of people in poor countries, and it won’t be in the future. In the next section, I’ll explain why and what it means for our climate strategies.

A few years ago, researchers at the University of Chicago’s Climate Impact Lab ran a thought experiment: What happens to the number of projected deaths from climate change when you account for the expected economic growth of low-income countries over the rest of this century? The answer: It falls by more than 50 percent.

This finding is exciting because it suggests a way forward. Since the economic growth that’s projected for poor countries will reduce climate deaths by half, it follows that faster and more expansive growth will reduce deaths by even more. And economic growth is closely tied to public health. So the faster people become prosperous and healthy, the more lives we can save.

When you look at the problem this way, it becomes easier to find the best buys in climate adaptation—they’re the areas where finance can do the most to fight poverty and boost health.

At the top of that list is improvements in agriculture.

Most poor countries are still largely agrarian economies. The average smallholder farmer in these countries has between two and four acres and makes about $2 a day. And she gets relatively little from her fields, about 80 percent less per acre than an American farmer. A single drought or flood can wipe her out for an entire season.

Lower emissions will eventually lead to fewer devastating losses, but today’s farmers don’t have time to wait for the climate to stabilize. They need to raise their incomes and feed their families now.

Mobile phones are already making a dramatic difference. Farmers use their phones to get advice on what to plant, when to plant, and when to fertilize that’s tailored by artificial intelligence to account for their soil, weather, and other local conditions. In India, during the most recent summer monsoon, around 40 million farmers in 13 states received an advance warning by SMS that the rains would arrive early and then pause. That single message saved millions of acres of crops.

And the technology is improving rapidly: In the next five years, a low-income farmer will be able to get better advice than anything that’s available to the richest farmers today.

Advances in crop breeding are another great buy, and Kenya has set an excellent example. Nearly 20 years ago, a group of African agricultural scientists saw that hotter, drier seasons were putting staple crops like maize under stress. So with support from the Gates Foundation and others, they developed a variety that could thrive in a changing climate. It worked: The new seeds gave a group of Kenyan farmers 66 percent more maize, enough to feed a family of six for a year and still have $880 worth of crops left over to sell. That’s equivalent to five months of income for them.

The list of innovations goes on. For example, researchers have helped farmers identify breeds of cattle that are naturally more resilient in tough conditions. And the new class of natural zero-emissions fertilizers I mentioned earlier is being tailored to the conditions in low-income countries. Scientists at the Tamil Nadu Agricultural University in India found that when smallholder farmers added these biofertilizers to their fields, their yields went up as much as 20 percent.   

Improvements like these need to go hand in hand with improvements in health. I think if you ask most people how they think climate will affect health, they’ll talk about heat waves and natural disasters. So let’s start there and look at the facts.

Excessively hot weather now causes around 500,000 deaths every year. Despite the impression you’d get from the news, though, the number has been decreasing for some time, chiefly because more people can afford air conditioners. And, surprisingly, excessive cold is far deadlier, killing nearly ten times more people every year than heat does. As for what will happen in the future, heat deaths will go up and cold deaths will go down. The best current estimates suggest that the net effect will be a global rise in temperature-related mortality, and that most of the increase will be in developing countries.  

The story so far with natural disasters is similar. In the past century, direct deaths from natural disasters, such as drowning during a flood, have fallen 90 percent to between 40,000 and 50,000 people a year, thanks mostly to better warning systems and more-resilient buildings.

But indirect deaths from natural disasters have not followed the same pattern of decline. In most cases today, people caught in storms and floods are more likely to die from a waterborne disease than from drowning. When floodwaters contaminate drinking water, they create ideal breeding grounds for cholera and rotavirus, which cause diarrhea and are especially deadly for children. More floods equals more diarrheal deaths.

But pathogens don’t wait around for storms or floods to infect people. Diarrheal diseases kill more than a million people a year, and the vast majority of infections don’t happen in a sudden tragic flash. They’re part of life in a low-income country. And, sadly, they’re not the only ongoing health threat.

If you include the other major causes of death in poor countries—malaria, TB, HIV/AIDS, respiratory infections, and complications from childbirth—poverty-related health problems kill about 8 million people a year.

And the burden is even worse when you factor in the health problems that don’t kill people but make them too sick to work, go to school, or take care of their kids. If a pregnant woman is already malnourished and then has her food supply cut off because of a flood, she’s even more likely to give birth prematurely, and her baby is more likely to start life underweight. But if she’s well-nourished to begin with, she and her baby have a much better chance to stay healthy.

I’m not saying we should ignore temperature-related deaths because diseases are a bigger problem. In fact, temperature-related deaths are one of the reasons why cheap clean energy is so important—it will make heating and air conditioning more affordable everywhere.

What I am saying is that we should deal with disease and extreme weather in proportion to the suffering they cause, and that we should go after the underlying conditions that leave people vulnerable to them. While we need to limit the number of extremely hot and cold days, we also need to make sure that fewer people live in poverty and poor health so that extreme weather isn’t such a threat to them.

Artificial intelligence has already begun to help do that. Today, for example, AI-powered devices make it possible for health workers to provide ultrasound exams for pregnant women in low-income settings—a breakthrough that means many more women will get the treatment they need to survive childbirth and deliver a healthy baby. AI is also helping researchers develop new vaccines and treatments faster, adding to the long list of affordable lifesaving tools that are already available, including vaccines, biofortified foods, bed nets, and treatments for diseases like AIDS, malaria, and tuberculosis.

The benefits of improving health and agriculture go beyond climate resilience. For example, as child survival rates go up, something unexpected takes place: People choose to have smaller families. When this happens, governments of poor countries can invest more in schools and health clinics, roads and ports, and sanitation systems and power grids. These things in turn make it easier to improve health and raise incomes. It is a remarkable virtuous cycle and it is set in motion by better health and agriculture.

In this memo, I’ve argued that we should measure success by our impact on human welfare more than our impact on the global temperature, and that our success relies on putting energy, health, and agriculture at the center of our strategies. 

Development doesn’t depend on helping people adapt to a warmer climate—development is adaptation.

Under Brazil’s leadership, adaptation and human development will get more attention at COP30 than at any other COP. That’s a promising first step.

For COP30 and beyond, I see two priorities that I hope the climate community will embrace.

1.

Drive the Green Premium to zero.

At each COP, governments take turns announcing commitments to lower their emissions. Unfortunately, this process doesn’t tell us which technologies are needed to meet those commitments, whether we have them yet, or what it will take to get them.

This is why, in addition to country-by-country commitments, every COP should have high-level discussions and commitments based on the five sectors. Policies and innovations in each sector need to get more visibility. Representatives from each of the five sectors should report on progress toward affordable and practical zero-carbon innovations, using the Green Premium as their yardstick.

Government leaders would get a view into whether they can meet their commitments with existing tools. They would see, sector by sector, which technologies they can start adopting now, which ones they should plan to roll out soon, and which ones still need government action to reduce the Green Premium. They would talk to their peers from other countries about working together on promising breakthroughs that will help everyone meet their commitments.

If you’re a policymaker, you can bring this sector-by-sector focus on the Green Premium to your government’s work. You can also protect funding for clean technologies and the policies that promote them. This is not just a public good: The countries that win the race to develop these breakthroughs will create jobs, hold enormous economic power for decades to come, and become more energy independent.

If you’re an activist, you can call for steps that make clean alternatives in every sector as cheap and practical as their fossil fuel counterparts. The public is more likely to switch to clean technology when it’s cheaper and better than fossil fuels.

If you’re a young scientist or entrepreneur, this is a moment to rethink what it means to change the world. The people working on clean materials today will have an enormous impact on human welfare. If you need pointers, the Climate Tech Map published last month by Breakthrough Energy and other partners is an excellent guide to the technologies that are essential for decarbonizing the economy. 

If you’re an investor, I encourage you to invest in companies working on high-impact clean technologies that will eventually have no Green Premium. I’m putting more of my own money into these efforts because reducing the Green Premium to zero demands more for-profit capital. It’s also a fantastic investment in what will be the biggest growth industry of the 21^st century. (I will give any profits I make from my investments to the Gates Foundation.)

2.

Be rigorous about measuring impact.

I wish there were enough money to fund every good climate change idea. Unfortunately, there isn’t, and we have to make tradeoffs so we can deliver the most benefit with limited resources. In these circumstances, our choices should be guided by data-based analysis that identifies ways to deliver the highest return for human welfare.

Vaccines are the undisputed champion of lives saved per dollar spent. Since 2000, Gavi has spent $22 billion to immunize children in poor countries, preventing 19 million deaths. That means Gavi can save a life for a little more than $1,000. Other estimates find that vaccines cost less than $5,000 per life saved. And vaccines become even more important in a warming world because children who aren’t dying of measles or whooping cough will be more likely to survive when a heat wave hits or a drought threatens the local food supply.

Every effort in the world’s climate agenda should undergo a similar analysis and be prioritized by its ability to save and improve lives cost-effectively. Malaria prevention, for example, is nearly as good as vaccines on the basis of cost per life saved. Energy innovation is a good buy not because it saves lives now, but because it will provide cheap clean energy and eventually lower emissions, which will have large benefits for human welfare in the future. Many of the best buys in agricultural innovation will be on display at COP30 in a showcase hosted by the Gates Foundation, the Brazilian government, and other partners.

This moment reminds me of another time when I called for a new direction. 

Thirty years ago, when I was running Microsoft, I wrote a long memo to employees about a major strategic pivot we had to make: embracing the internet in every product we made. 

It seems like an obvious move now, given that online activity is such an integral part of everyone’s life, but at the time, the internet was just entering the mainstream. If we hadn’t adjusted our strategy, our success would have been at risk.

For a company, it's relatively easy to make a shift like that because there’s only one person in charge. By contrast, there is no CEO who sets the world’s climate priorities or strategies, which is exactly as it should be. These are rightly determined by the global climate community.

So I urge that community, at COP30 and beyond, to make a strategic pivot: prioritize the things that have the greatest impact on human welfare. It’s the best way to ensure that everyone gets a chance to live a healthy and productive life no matter where they’re born, and no matter what kind of climate they’re born into. 

I’m lucky to learn firsthand about some of the world’s most cutting-edge technologies. I’ve seen artificial intelligence ace an AP biology test, long before AI became an everyday tool. I've seen genetically modified mosquitoes stop malaria in its tracks. I've seen geothermal wells go 15,000 feet below the surface of the earth.

But if I had to pick the coolest thing I work on, it's hard to beat harnessing the power of atoms to fuel our world.

Both fission energy and fusion energy release large amounts of energy by altering the nucleus of an atom. Fission already provides safe, reliable clean electricity around the world, and I believe that fusion will too one day soon. And both will play a key role in meeting humanity’s growing need for energy while also eliminating carbon emissions

The two technologies often get lumped together, which is understandable given how similar they seem on the surface. But the reality is that, in many ways, fission and fusion are opposites. Knowing how each one works—and why they are different—is critical to understanding the roles they will play in the decades ahead.  

When people talk about “nuclear power,” they are almost always talking about fission. Fission has been powering homes around the world since 1954 (the year before I was born!). Although the technology has evolved a lot over the years—and continues to improve, as I’ll explain—the fundamental physics remains the same.

The nucleus of every atom is made up of subatomic particles called protons and neutrons. Some atoms, like uranium-235, have unusually large and heavy nuclei that make them unstable. If you fire a neutron at a uranium-235 atom, its nucleus breaks apart into smaller atoms—releasing energy in the form of heat. (The amount of energy released is enormous: the change in the mass of the atom times the speed of light squared. You may know this as E=mc².)

As the nucleus splits, it also releases its neutrons. These neutrons bounce around at incredible speeds until some eventually collide with other nuclei. This sets off a chain reaction as each collision results in the release of more heat and more neutrons.

The heat created by this chain reaction is harnessed to turn water into steam. The steam is then used to turn turbines, which convert the motion into electricity. This power is sent via the power grid into homes and businesses—all without releasing any harmful emissions into the atmosphere.

These steps form the backbone of all fission power, but beyond the core reaction, there are lots of different ways to build a nuclear power plant. Most use pressurized water to keep the core at a stable temperature. Others use carbon dioxide gas or something called heavy water. TerraPower, the nuclear company I started back in 2008, uses liquid sodium.  

I first became interested in fission twenty years ago when I asked a couple of my smart physicist friends if there was a better way to build nuclear power plants. Nuclear has lots of advantages, but it has some challenges: The plants are expensive to build, and human error can cause accidents. We need next-generation nuclear technology that solves these problems, which is where TerraPower fits in.

The company’s Natrium reactor is far safer than any existing plant, with the temperatures held under control by the laws of physics instead of human operators who can make mistakes. It has a shorter construction timeline, is cheaper to run, and can be operated by former fossil plant workers with minimal retraining. And, when the plant comes online in 2030, it will be reliable, providing dependable power throughout the day and night.

Fission energy is a well-established technology that we’re trying to improve. In contrast, generating electricity from fusion is something totally new.

While fission is all about splitting atoms, fusion is all about combining them. Fusion is the reaction that powers the sun and stars, but it has been a decades-long challenge to reproduce those intense conditions here on Earth. Now it’s within reach for reasons I will explain, but first, you need to understand how fusion works.

You start with a simple gas like hydrogen. If you make it extraordinarily hot while it’s in an electrically charged state known as plasma, the particles start moving so fast that they hit one another and fuse together.

When the hydrogen atoms fuse, they become helium. In the process, they release a great deal of heat. This reaction is what powers the sun, and it can be used to turn water into steam that pushes a turbine and generates electricity.

The challenge is getting the hydrogen particles hot enough to fuse. Because the sun is so large, the gravitational pressure in its core creates temperatures around a mind-blowing 15 million degrees Celsius. Here on Earth, one way to reach the right temperatures is by containing the plasma inside a magnetic field—although this is hard to do without using more energy than you generate. Scientists are experimenting with different kinds of devices, including the donut-shaped tokamak and the twisted spiral stellarator.

Once a fusion reaction is up and running, it’s totally safe. There’s no chain reaction to run out of control, because the fusion ceases as soon as you stop supplying fuel or switch off the device that’s containing the plasma. (Fun fact: Fusion machines are regulated as the same class of technology as MRI machines.) Plus, the fuel is cheap and plentiful. The process uses two types of hydrogen that are extracted from sea water and created inside the fusion machine itself.

Researchers have been chasing the dream of commercial fusion power generation since the 1950s. Although they learned a ton about the science in the process, fusion power remained elusive—until 2022. That’s when scientists at Lawrence Livermore National Laboratory in California achieved what is called “ignition”: the moment when heat from the fusion process helped sustain the reaction, a key step toward commercial fusion energy’s requirement of releasing more energy that was put in.

In just three years since then, the race to commercialize fusion energy has sped up. Commonwealth Fusion Systems, a company I support through Breakthrough Energy, is the farthest along: They’re on track to put power on the grid in the early 2030s using their tokamak called ARC, which is compact and uses high-temperature superconductors to create the magnetic field. Other companies making terrific progress include Marathon Fusion, Type One Energy, Xcimer, and Zap Energy.

It's great to see so many companies trying different approaches to fusion energy. As those designs come out, we’ll have to see which is the cheapest way to generate the heat that you turn into electricity. The more designs we have that work, the more likely it is we’ll be able to lower the cost of electricity significantly compared to today.

The first TerraPower plant is currently being built in Kemmerer, Wyoming. Many of the facilities’ support buildings are well underway, and construction is about to begin on the “energy island,” where the steam turbines and other machinery that generate power will sit. The Nuclear Regulatory Commission is currently reviewing the company’s application to start on the actual nuclear reactor. I’m hopeful that we’ll start building the “nuclear island” next year, ahead of the plant coming online in 2030. And once the first plant is up and running, it’ll be much faster and cheaper to build additional plants.

Fusion power is a bit further away but still coming in the near-term future. CFS expects to see its SPARC prototype demonstrate net fusion energy within the next two years. They’ve secured the site of their first power plant in Chesterfield County, VA, and they’ve already signed two major customers: Google and Eni, an Italy-based global energy company. I’m optimistic the ARC power plant will come online within the next decade. When that day comes, it will be a huge win for America’s energy independence—and for the world’s quest for abundant sustainable energy.

Consider this: If you know how to build a fusion power plant, you can have unlimited energy anywhere and forever. It’s hard to overstate what a big deal that will be. The availability and affordability of electricity is a huge limiting factor for virtually every sector of the economy today. Removing those limits could be as transformative as the invention of the steam engine before the Industrial Revolution.

This transformation will dramatically improve human welfare around the world—and especially for the world’s most vulnerable people. Making cheap electricity is super important. If you don’t have power, there’s a real limit to how much you can develop economically. As crazy as it seems now, I believe that we will one day be able to put fission and fusion power plants in the most remote parts of the world.

The biggest challenge is, as with all technology development, building the first one. Once you’ve proven that your concept works, it is exponentially easier and cheaper to build the second plant, and then the third plant, and so on. Eventually, the price of electricity will come down even below the cheapest way we make electricity today.

Both fission and fusion are fundamental technologies for humanity to power everything we do. We’re on the cusp of massive breakthroughs, and it’s clearer now than even before: The future of energy is subatomic.

Hello from Kemmerer, Wyoming! It’s been just over a year since my last visit, and I’m blown away by how much has changed.

One of the oldest buildings in downtown Kemmerer—once an opera house—has been restored and is now home to a mercantile and a bakery. Just down the street, the owners of the local coffee shop have purchased an 100-year-old building to expand their operation. A law office has opened, and city officials tell me that plans are moving forward for new multi- and single-family housing developments.

I’m thrilled to see so much economic growth happening, because Kemmerer will soon be home to the most advanced nuclear facility in the world. I just left the groundbreaking ceremony for the first-ever Natrium plant, which will bring safe, next-generation nuclear technology to life right here in Wyoming. It’s a huge milestone for the local economy, America’s energy independence, and the fight against climate change.

Today is a big one for Kemmerer—for the coal plant workers who will be able to see their future job site being constructed across the highway, for the local construction workers who will be part of a 1,600-person skilled labor force building the plant, and for the local businesses that will take care of the new workforce. 

The plant was designed by TerraPower, a company I started in 2008. But my nuclear journey started several years earlier, when I first read a scientific paper for a new type of nuclear power plant.

The design was far safer than any existing plant, with the temperatures held under control by the laws of physics instead of human operators who can make mistakes. It would have a shorter construction timeline and be cheaper to operate. And it would be reliable, providing dependable power throughout the day and night. As I looked at the plans for this new reactor, I saw how rethinking nuclear power could overcome the barriers that had hindered it—and revolutionize how we generate power in the U.S. and around the world.

So, we started TerraPower, where nuclear scientists could take the concept and transform it into a reality. Since then, the amazing team at TerraPower has proven we can do nuclear better. They are leading the country—and the world—in developing safe, next-generation nuclear technology.

But that technology was just an idea in a lab and on a computer screen until today.

You can read more about the super cool science behind the Natrium plant here. Now that we’ve broken ground, the first order of business is to build the sodium test facility, which will test components and transfer the liquid sodium that will be used to cool the nuclear reactor. Construction will continue over the years ahead before the plant hopefully comes online in 2030.

For a project this big and this important to work, it takes private companies partnering with public leaders and governments. I can’t say enough good things about Mayor Bill Thek, Mayor Mark Langley, and the remarkable communities here in Kemmerer and Diamondville, who have embraced this project.

Today couldn’t have happened without the Department of Energy’s Advanced Reactor Demonstration Program, which is supporting the project with the largest single contribution the federal government has ever committed to a private project. If we’re going to solve climate change, it’s going to take courage, commitment, and partnership between the federal government and private industry, a point that Secretary of Energy Jennifer Granholm has made repeatedly. Gov. Mark Gordon and Senators John Barrasso and Cynthia Lummis have been true champions, and we’re grateful for the support from TerraPower’s investors and development partners, including Bechtel, GE Hitachi, PacifiCorp, and Berkshire Hathaway.

What’s next? The U.S. Nuclear Regulatory Commission accepted TerraPower’s construction permit application for review last month. It’s a step that sounds bureaucratic but is, in fact, a huge deal and the first time something like this has happened with a commercial non-light water reactor in more than 40 years. This step starts the review process at the NRC for the permit application—once it is approved, construction can begin on the actual nuclear reactor.

The review process will take a couple of years, so in the meantime, TerraPower will continue to build the non-nuclear parts of the facility. Construction will begin next year on the so-called “energy island,” which is where the steam turbines and other machinery that actually generate power will sit. (The reactor will eventually be part of a “nuclear island,” and the team hopes to start building that in 2026.)

While these first-of-a-kind projects can be big and risky, they are too important for our future to fail to act. I’m proud of all those who have helped ensure the most advanced nuclear project in the world gets built right here in the United States.

I believe that the next-generation nuclear power plant that TerraPower is building here will power the future of our nation—and the world. Everything we do runs on electricity: buildings, technology, and increasingly transportation. To meet our economic and climate goals, we need more abundant clean energy, not less. The ground we broke in Kemmerer will soon be the bedrock of America’s energy future. Today, we took the biggest step yet toward safe, abundant, zero-carbon energy. 

A core principle underlying the Gates Foundation’s work is closing the innovation gap between rich countries and everyone else. People in poorer parts of the world shouldn’t have to wait decades for new technologies to reach them. That’s why we've worked for 25 years to accelerate access to life-saving medicines and vaccines in low- and middle-income countries.

It's also why, today, the Gates Foundation and OpenAI are announcing an initiative called Horizon 1000 to support several countries in Africa, starting in Rwanda, as they apply AI technology to improve their health care systems.

Over the next few years, we will collaborate with leaders in African countries as they pioneer the deployment of AI in health. Together, the Gates Foundation and OpenAI are committing $50 million in funding, technology, and technical support to back their work. The goal is to reach 1,000 primary healthcare clinics and their surrounding communities by 2028.

Today’s AI can help save lives

A few years ago, I wrote that the rise of artificial intelligence would mark a technological revolution as far-reaching for humanity as microprocessors, PCs, mobile phones, and the Internet. Everything I’ve seen since then confirms my view that we are on the cusp of a breathtaking global transformation.

All over the world, AI, in the form of LLMs and machine learning models, are improving far more quickly than I first anticipated. From science to education to customer service and more, AI tools are reshaping every facet of our lives.

I spend a lot of time thinking about how AI can help us address fundamental challenges like poverty, hunger, and disease. One issue that I keep coming back to is making great health care accessible to all—and that’s why we’re partnering with OpenAI and African leaders and innovators on Horizon 1000.

Not enough doctors in the house

We have seen amazing successes in global health over the past 25 years: child mortality has been cut in half, and there are now real pathways to eliminating or controlling deadly diseases like polio, malaria, TB, and HIV. But one stubborn problem that keeps slowing progress is the desperate shortage of health care workers in poorer parts of the world.

In Sub-Saharan Africa, which suffers from the world’s highest child mortality rate, there is a shortfall of nearly 6 million health care workers, a gap so large that even the most aggressive hiring and training efforts can’t close it in the foreseeable future.

These huge shortages put health care workers in these countries in an impossible situation. They’re forced to triage too many patients with too little administrative support, modern technology, and up-to-date clinical guidance. Partly as a result, the WHO estimates that low-quality care is a contributing factor in 6 to 8 million deaths in low- and middle-income countries every year, and that’s not even counting the millions who die because they aren’t able to access health care at all.

Rwanda leads the way

Today’s AI can help save those lives by reaching many more people with much higher-quality care.

Rwanda currently has only one health care worker per 1,000 people, far below the WHO recommendation of about four per 1,000. It would take 180 years for that gap to close at the current pace of progress. So, as part of the 4x4 reform initiative, Minister of Health Dr. Sabin Nsanzimana recently announced the launch of an AI-powered Health Intelligence Center in Kigali to help ensure limited health care resources are being used as wisely as possible.

As part of the Horizon 1000 initiative, we aim to accelerate the adoption of AI tools across primary care clinics, within communities, and in people’s homes. These AI tools will support health workers, not replace them.

On the horizon

Minister Nsanzimana has called AI the third major discovery to transform medicine, after vaccines and antibiotics, and I agree with his point of view. 

If you live in a wealthier country and have seen a doctor recently, you may have already seen how AI is making life easier for health care workers. Instead of taking notes constantly, they can now spend more time talking directly to you about your health, while AI transcribes and summarizes the visit. Afterwards, AI can handle much of the onerous paperwork, so doctors and nurses can focus on the next patient.

In poorer countries with enormous health worker shortages and lack of health systems infrastructure, AI can be a gamechanger in expanding access to quality care. I believe this partnership with OpenAI, governments, innovators, and health workers in sub-Saharan Africa is a step towards the type of AI we need more of: systems that help people all over the world to solve generational challenges that they simply didn’t know how to address before. I invite others working on AI to think about how we can put these massively powerful tools to the best use.

This announcement is a great example of why I remain optimistic about the improvements we can make. I’m looking forward to seeing health workers using some of these AI solutions in action when I visit Africa, and I plan to continue focusing on ways AI technology can help billions of people in low- and middle-income countries meet their most important needs.

I still love software as much today as I did when Paul Allen and I started Microsoft. But—even though it has improved a lot in the decades since then—in many ways, software is still pretty dumb.

To do any task on a computer, you have to tell your device which app to use. You can use Microsoft Word and Google Docs to draft a business proposal, but they can’t help you send an email, share a selfie, analyze data, schedule a party, or buy movie tickets. And even the best sites have an incomplete understanding of your work, personal life, interests, and relationships and a limited ability to use this information to do things for you. That’s the kind of thing that is only possible today with another human being, like a close friend or personal assistant.

In the next five years, this will change completely. You won’t have to use different apps for different tasks. You’ll simply tell your device, in everyday language, what you want to do. And depending on how much information you choose to share with it, the software will be able to respond personally because it will have a rich understanding of your life. In the near future, anyone who’s online will be able to have a personal assistant powered by artificial intelligence that’s far beyond today’s technology.

This type of software—something that responds to natural language and can accomplish many different tasks based on its knowledge of the user—is called an agent. I’ve been thinking about agents for nearly 30 years and wrote about them in my 1995 book The Road Ahead, but they’ve only recently become practical because of advances in AI.

Agents are not only going to change how everyone interacts with computers. They’re also going to upend the software industry, bringing about the biggest revolution in computing since we went from typing commands to tapping on icons.

A personal assistant for everyone

Some critics have pointed out that software companies have offered this kind of thing before, and users didn’t exactly embrace them. (People still joke about Clippy, the digital assistant that we included in Microsoft Office and later dropped.) Why will people use agents?

The answer is that they’ll be dramatically better. You’ll be able to have nuanced conversations with them. They will be much more personalized, and they won’t be limited to relatively simple tasks like writing a letter. Clippy has as much in common with agents as a rotary phone has with a mobile device.

An agent will be able to help you with all your activities if you want it to. With permission to follow your online interactions and real-world locations, it will develop a powerful understanding of the people, places, and activities you engage in. It will get your personal and work relationships, hobbies, preferences, and schedule. You’ll choose how and when it steps in to help with something or ask you to make a decision.

To see the dramatic change that agents will bring, let’s compare them to the AI tools available today. Most of these are bots. They’re limited to one app and generally only step in when you write a particular word or ask for help. Because they don’t remember how you use them from one time to the next, they don’t get better or learn any of your preferences. Clippy was a bot, not an agent.

Agents are smarter. They’re proactive—capable of making suggestions before you ask for them. They accomplish tasks across applications. They improve over time because they remember your activities and recognize intent and patterns in your behavior. Based on this information, they offer to provide what they think you need, although you will always make the final decisions.

Imagine that you want to plan a trip. A travel bot will identify hotels that fit your budget. An agent will know what time of year you’ll be traveling and, based on its knowledge about whether you always try a new destination or like to return to the same place repeatedly, it will be able to suggest locations. When asked, it will recommend things to do based on your interests and propensity for adventure, and it will book reservations at the types of restaurants you would enjoy. If you want this kind of deeply personalized planning today, you need to pay a travel agent and spend time telling them what you want.

The most exciting impact of AI agents is the way they will democratize services that today are too expensive for most people. They’ll have an especially big influence in four areas: health care, education, productivity, and entertainment and shopping.

Health care

Today, AI’s main role in healthcare is to help with administrative tasks. Abridge, Nuance DAX, and Nabla Copilot, for example, can capture audio during an appointment and then write up notes for the doctor to review.

The real shift will come when agents can help patients do basic triage, get advice about how to deal with health problems, and decide whether they need to seek treatment. These agents will also help healthcare workers make decisions and be more productive. (Already, apps like Glass Health can analyze a patient summary and suggest diagnoses for the doctor to consider.) Helping patients and healthcare workers will be especially beneficial for people in poor countries, where many never get to see a doctor at all.

These clinician-agents will be slower than others to roll out because getting things right is a matter of life and death. People will need to see evidence that health agents are beneficial overall, even though they won’t be perfect and will make mistakes. Of course, humans make mistakes too, and having no access to medical care is also a problem.

Mental health care is another example of a service that agents will make available to virtually everyone. Today, weekly therapy sessions seem like a luxury. But there is a lot of unmet need, and many people who could benefit from therapy don’t have access to it. For example, RAND found that half of all U.S. military veterans who need mental health care don’t get it.

AI agents that are well trained in mental health will make therapy much more affordable and easier to get. Wysa and Youper are two of the early chatbots here. But agents will go much deeper. If you choose to share enough information with a mental health agent, it will understand your life history and your relationships. It’ll be available when you need it, and it will never get impatient. It could even, with your permission, monitor your physical responses to therapy through your smart watch—like if your heart starts to race when you’re talking about a problem with your boss—and suggest when you should see a human therapist.

Education

For decades, I’ve been excited about all the ways that software would make teachers’ jobs easier and help students learn. It won’t replace teachers, but it will supplement their work—personalizing the work for students and liberating teachers from paperwork and other tasks so they can spend more time on the most important parts of the job. These changes are finally starting to happen in a dramatic way.

The current state of the art is Khanmigo, a text-based bot created by Khan Academy. It can tutor students in math, science, and the humanities—for example, it can explain the quadratic formula and create math problems to practice on. It can also help teachers do things like write lesson plans. I’ve been a fan and supporter of Sal Khan’s work for a long time and recently had him on my podcast to talk about education and AI.

But text-based bots are just the first wave—agents will open up many more learning opportunities.

For example, few families can pay for a tutor who works one-on-one with a student to supplement their classroom work. If agents can capture what makes a tutor effective, they’ll unlock this supplemental instruction for everyone who wants it. If a tutoring agent knows that a kid likes Minecraft and Taylor Swift, it will use Minecraft to teach them about calculating the volume and area of shapes, and Taylor’s lyrics to teach them about storytelling and rhyme schemes. The experience will be far richer—with graphics and sound, for example—and more personalized than today’s text-based tutors.

Productivity

There’s already a lot of competition in this field. Microsoft is making its Copilot part of Word, Excel, Outlook, and other services. Google is doing similar things with Assistant with Bard and its productivity tools. These copilots can do a lot—such as turn a written document into a slide deck, answer questions about a spreadsheet using natural language, and summarize email threads while representing each person’s point of view.

Agents will do even more. Having one will be like having a person dedicated to helping you with various tasks and doing them independently if you want. If you have an idea for a business, an agent will help you write up a business plan, create a presentation for it, and even generate images of what your product might look like. Companies will be able to make agents available for their employees to consult directly and be part of every meeting so they can answer questions.

Whether you work in an office or not, your agent will be able to help you in the same way that personal assistants support executives today. If your friend just had surgery, your agent will offer to send flowers and be able to order them for you. If you tell it you’d like to catch up with your old college roommate, it will work with their agent to find a time to get together, and just before you arrive, it will remind you that their oldest child just started college at the local university.

Entertainment and shopping

Already, AI can help you pick out a new TV and recommend movies, books, shows, and podcasts. Likewise, a company I’ve invested in, recently launched Pix, which lets you ask questions (“Which Robert Redford movies would I like and where can I watch them?”) and then makes recommendations based on what you’ve liked in the past. Spotify has an AI-powered DJ that not only plays songs based on your preferences but talks to you and can even call you by name.

Agents won’t simply make recommendations; they’ll help you act on them. If you want to buy a camera, you’ll have your agent read all the reviews for you, summarize them, make a recommendation, and place an order for it once you’ve made a decision. If you tell your agent that you want to watch Star Wars, it will know whether you’re subscribed to the right streaming service, and if you aren’t, it will offer to sign you up. And if you don’t know what you’re in the mood for, it will make customized suggestions and then figure out how to play the movie or show you choose.

You’ll also be able to get news and entertainment that’s been tailored to your interests. CurioAI, which creates a custom podcast on any subject you ask about, is a glimpse of what’s coming.

A shock wave in the tech industry

In short, agents will be able to help with virtually any activity and any area of life. The ramifications for the software business and for society will be profound.

In the computing industry, we talk about platforms—the technologies that apps and services are built on. Android, iOS, and Windows are all platforms. Agents will be the next platform.

To create a new app or service, you won’t need to know how to write code or do graphic design. You’ll just tell your agent what you want. It will be able to write the code, design the look and feel of the app, create a logo, and publish the app to an online store. OpenAI’s launch of GPTs this week offers a glimpse into the future where non-developers can easily create and share their own assistants.

Agents will affect how we use software as well as how it’s written. They’ll replace search sites because they’ll be better at finding information and summarizing it for you. They’ll replace many e-commerce sites because they’ll find the best price for you and won’t be restricted to just a few vendors. They’ll replace word processors, spreadsheets, and other productivity apps. Businesses that are separate today—search advertising, social networking with advertising, shopping, productivity software—will become one business.

I don’t think any single company will dominate the agents business--there will be many different AI engines available. Today, agents are embedded in other software like word processors and spreadsheets, but eventually they’ll operate on their own. Although some agents will be free to use (and supported by ads), I think you’ll pay for most of them, which means companies will have an incentive to make agents work on your behalf and not an advertiser’s. If the number of companies that have started working on AI just this year is any indication, there will be an exceptional amount of competition, which will make agents very inexpensive.

But before the sophisticated agents I’m describing become a reality, we need to confront a number of questions about the technology and how we’ll use it. I’ve written before about the issues that AI raises, so I’ll focus specifically on agents here.

The technical challenges

Nobody has figured out yet what the data structure for an agent will look like. To create personal agents, we need a new type of database that can capture all the nuances of your interests and relationships and quickly recall the information while maintaining your privacy. We are already seeing new ways of storing information, such as vector databases, that may be better for storing data generated by machine learning models.

Another open question is about how many agents people will interact with. Will your personal agent be separate from your therapist agent and your math tutor? If so, when will you want them to work with each other and when should they stay in their lanes?

How will you interact with your agent? Companies are exploring various options including apps, glasses, pendants, pins, and even holograms. All of these are possibilities, but I think the first big breakthrough in human-agent interaction will be earbuds. If your agent needs to check in with you, it will speak to you or show up on your phone. (“Your flight is delayed. Do you want to wait, or can I help rebook it?”) If you want, it will monitor sound coming into your ear and enhance it by blocking out background noise, amplifying speech that’s hard to hear, or making it easier to understand someone who’s speaking with a heavy accent.

There are other challenges too. There isn’t yet a standard protocol that will allow agents to talk to each other. The cost needs to come down so agents are affordable for everyone. It needs to be easier to prompt the agent in a way that will give you the right answer. We need to prevent hallucinations, especially in areas like health where accuracy is super-important, and make sure that agents don’t harm people as a result of their biases. And we don’t want agents to be able to do things they’re not supposed to. (Although I worry less about rogue agents than about human criminals using agents for malign purposes.)

Privacy and other big questions

As all of this comes together, the issues of online privacy and security will become even more urgent than they already are. You’ll want to be able to decide what information the agent has access to, so you’re confident that your data is shared with only people and companies you choose.

But who owns the data you share with your agent, and how do you ensure that it’s being used appropriately? No one wants to start getting ads related to something they told their therapist agent. Can law enforcement use your agent as evidence against you? When will your agent refuse to do something that could be harmful to you or someone else? Who picks the values that are built into agents?

There’s also the question of how much information your agent should share. Suppose you want to see a friend: If your agent talks to theirs, you don’t want it to say, "Oh, she’s seeing other friends on Tuesday and doesn’t want to include you.” And if your agent helps you write emails for work, it will need to know that it shouldn’t use personal information about you or proprietary data from a previous job.

Many of these questions are already top-of-mind for the tech industry and legislators. I recently participated in a forum on AI with other technology leaders that was organized by Sen. Chuck Schumer and attended by many U.S. senators. We shared ideas about these and other issues and talked about the need for lawmakers to adopt strong legislation.

But other issues won’t be decided by companies and governments. For example, agents could affect how we interact with friends and family. Today, you can show someone that you care about them by remembering details about their life—say, their birthday. But when they know your agent likely reminded you about it and took care of sending flowers, will it be as meaningful for them?

In the distant future, agents may even force humans to face profound questions about purpose. Imagine that agents become so good that everyone can have a high quality of life without working nearly as much. In a future like that, what would people do with their time? Would anyone still want to get an education when an agent has all the answers? Can you have a safe and thriving society when most people have a lot of free time on their hands?

But we’re a long way from that point. In the meantime, agents are coming. In the next few years, they will utterly change how we live our lives, online and off.

Do you know how to calculate the volume of a prism? What about a pyramid? And what does either have to do with movie theater popcorn?

Back in April, I spent the day at Chula Vista Middle School in Southern California learning what these questions have to do with graduating from college. I was there to meet with school and district leaders and join an eighth-grade math class taught by a remarkable teacher named Amilcar Fernandez, who also runs the math department and develops its curriculum. Over the past few years, Mr. Fernandez has been trying to transform how Chula Vista teaches what is widely cited as American students’ “least favorite subject”—and has been since at least the year I was born.

While my love of math is no secret, I know many people don’t feel similarly. To them, the subject often feels abstract, even irrelevant. And with the rise of calculators, then computers, and now AI chatbots, it’s getting harder and harder to explain to students why they should learn how to do long division or find the area of a trapezoid by hand.

The truth is that math is more than just a bunch of numbers—much more. Not only are math skills relevant to our everyday lives in ways we might not realize, they’re also a powerful indicator of how successful those lives will be. As I’ve written in the past, research shows that students who pass Algebra 1 by ninth grade are more likely to earn a bachelor’s degree (in any major) and go on to a well-paid career. If they fail the course, they only have a one-in-five chance of graduating from high school.

So it’s critical that students build the foundation in math they need to take on that tough course, which is the most frequently failed high school course in the country. But so many don’t. Earlier this year, the National Assessment Governing Board released its Long-Term Trend Report, which showed that math scores for 13-year-old students in seventh and eighth grade fell nine points compared to 2020 and 14 points compared to a decade ago—dropping to levels not seen since the 1990s.

But even prior to the pandemic, students were struggling. In 2019, the last year of data we have before it upended education around the world, just 34 percent of U.S. eighth graders were proficient in math. For too many, the subject is a barrier to success instead of a gateway.

That’s not because students can’t keep up with what is being taught in math class; it’s because what is being taught in math class hasn’t kept up with them. Over the past several decades, the way that algebra, geometry, and calculus are taught has barely changed—despite tremendous transformation in the labor market, and despite polling that shows parents and teachers believe math education should be more applicable to the real world (and evidence that suggests students’ engagement and understanding in math increase when it is). 

That is why the Gates Foundation’s K-12 education strategy is focused on improving student outcomes by modernizing math education. To us, that means three things. First, it should be personalized to students and their respective interests, abilities, needs, and goals, with feedback tailored to them and opportunities to work on some topics or problems of their choosing. Second, it should prioritize interaction and communication by encouraging students to talk through their problem-solving approaches out loud and collaborate to find the answers, which can build their confidence and allow them to learn from each other. Third, it should be applicable (and applied) to complex, real-world problems that students know exist outside the classroom—from designing a budget to estimating population growth.

I got to see these three key concepts in action during the day I spent in Chula Vista. The school is part of one of the foundation’s two Networks for School Improvement run by the High Tech High Graduate School of Education. They’re focused on helping more eighth graders get on track by supporting teachers like Mr. Fernandez as they work to improve the way math, specifically, is taught and learned—and how students are engaged in the process.

The lesson for the day was one that most middle-schoolers learn at some point: how to calculate the volume of a pyramid. But Mr. Fernandez’s approach to teaching it was different. Rather than give students the formula and have them practice it over and over again, he put the pyramid in their hands—literally, with a pyramid-shaped popcorn container—and asked them to take the lead in their own learning. The question he asked to start the lesson off wasn’t “What is the volume?” but “Which of these two popcorn containers—one a rectangular prism, and one a pyramid—would you buy at the movie theater to get the best deal?”

By approaching the lesson this way, Mr. Fernandez gave his students a real-world application that they’ve likely already encountered—and an incentive to learn the answer. After all, who doesn’t want to get the most bang for their buck? Then he had his students talk through what they already knew about volume, and about how the area of four-sided 2D shapes relates to the area of three-sided ones.

I loved watching the students answer each other’s questions, and I was impressed by how Mr. Fernandez empowered all of them to speak up. As he explained to me afterward, one of the reasons he’s able to do that is because of the feedback he receives and then implements from frequent student surveys. While he certainly wants and solicits student input on his performance as a teacher, the specific surveys he gives do more than that: They also measure engagement and relevance by allowing students to give feedback on how they are experiencing the classroom.

Studies have shown that students are more than twice as likely to earn As and Bs in math when they rate classroom learning conditions highly, which happens when they feel a sense of agency and belonging there. Mr. Fernandez knows firsthand how critical those factors are. Chula Vista is under ten miles from the border with Mexico, and most of his students are either the children of immigrants or immigrants themselves. Fernandez is a first-generation American, too. From the surveys, he knows that many of his students bring that part of their identity into the classroom—either insecure about English as a second language, or unsure about college because no one in their family has gone, or simply unconvinced that math is relevant to their lives in the grand scheme of things.

But because Mr. Fernandez understands and relates to his students’ experiences, he can make them feel seen, and like they belong, in the classroom. That, coupled with his applications of math to real-world contexts that pique his students' interest, ends up increasing their engagement. At Chula Vista, math proficiency rates have increased 18 percentage points in the last three years—a sign that these efforts are making an impact.  

Sometimes, the math problem in this country feels impossible to solve. But when more teachers have the tools they need to reach their students—and teach math in a way that resonates—I’m confident that more of their students will graduate with a love of math just like mine.

When I was a kid, my parents took me to the World’s Fair in Seattle. It was amazing to see all these fantastic technologies that felt like something out of a science fiction novel. I asked them to take me back multiple times during the six months it was open here, and I remember walking away from the fairgrounds each time feeling that I had just caught a glimpse of the future.

That feeling came back to me recently as I walked out of a classroom in Newark, New Jersey.

In May, I had the chance to visit the First Avenue Elementary School, where they’re pioneering the use of AI education in the classroom. The Newark School District is piloting Khanmigo, an AI-powered tutor and teacher support tool, and I couldn’t wait to see it for myself.

I’ve written a lot about Khanmigo on this blog. It was developed by Khan Academy, a terrific partner of the Gates Foundation. And I think Sal Khan, the founder of Khan Academy, is a visionary when it comes to harnessing the power of technology to help kids learn. (You can read my review of his new book, Brave New Words, here.)

We’re still in the early days of using AI in classrooms, but what I saw in Newark showed me the incredible potential of the technology.

I was blown away by how creatively the teachers were using the tools. Leticia Colon, an eighth-grade algebra teacher, explained how she used AI to create problem sets about hometown heroes the students might be interested in. In February, Khanmigo helped her develop equations that incorporated Newark boxer Shakur Stevenson’s workout routines, so her students could practice math skills while learning about a real-world role model.

Cheryl Drakeford, a third-grade math and science teacher, talked about how she uses Khanmigo to help create rubrics and lesson hooks for assignments. The technology gives her a first draft, which she then tailors for her students. For example, the AI once gave her a hook that used a generic story about a fruit stand, and she edited it to be about Pokémon cards and Roblox—two topics her students are passionate about. “Khanmigo gives me the blueprint, but I have to give the delivery,” she said.

Several of the teachers I met with showed me how they can access each student’s dashboard and get a summary of how they’re doing in a particular subject. They loved being able to easily and quickly track a student’s progress, because it’s saving them a lot of time. They were also excited about how their students are using Khanmigo as a personalized tutor.

This technology is far from perfect at this point. Although the students I met loved using Khanmigo overall, they also mentioned that it struggled to pronounce Hispanic names and complained that its only voice option is male—which makes it clear how much thought must still be put into making the technology inclusive and engaging for all students. In an ideal world, the AI would know what the students in Ms. Drakeford’s class are into, so she wouldn’t have to do any editing. And Ms. Colon told me it took her several tries to get Khanmigo to give her what she wanted.

In other words, my visit to Newark showed me where we are starting from with AI in the classroom, not where the technology will end up eventually. It reinforced my belief that AI will be a total game-changer for both teachers and students once the technology matures. Even today, when the teachers at First Avenue delegate routine tasks to AI assistants, they reclaim time for what matters most: connecting with students, sparking curiosity, and making sure every child feels seen and supported—especially those who need a little extra help.

Khanmigo is just one of many AI-powered education tools in the pipeline, and the Gates Foundation is focused on ensuring these tools reach and support all students, not just a few. Our goal is that they help level the playing field, not widen existing gaps. We’re currently working with educators across the country to get feedback and make the technology more responsive to their needs. Visits like the one I took to Newark are part of that process. It was fantastic to learn what teachers were enthused about and see how different students are engaging with AI.

The educators I met in Newark are true pioneers. Some were on the cutting edge, constantly looking for new ways to use AI in their classroom. Others were using it in a more limited fashion. I was impressed by how the school was able to support each teacher’s comfort level with the technology. They’re putting a lot of thought into change management and making sure that no educator is forced to try things that won’t work in their classroom.  

That’s because, at the end of the day, teachers know best. If you hand them the right tools, they will always find a way to support their students. My visit to Newark left me more optimistic than ever that AI will help teachers do what they do best and free them up to focus on what matters most.

When I was in high school, one of my favorite classes was drama. A teacher pushed me to sign up, and I was fully prepared to hate it—but I fell in love with acting. Drama pushed me to broaden myself, try something new, and see if I could succeed. I even gained enough confidence to audition for—and get—the lead in “Black Comedy,” the school play my senior year.

Blaire Penry, the 2024 Washington State Teacher of the Year, understands how transformative a class like drama can be, because she’s seen it happen with her own students. And I was blown away by how she uses technology to reimagine how students engage in the classroom.

Blaire teaches career and technical education, or CTE, and fine arts in the Auburn School District, which is located about 30 miles south of Seattle. Over the years, she has taught a wide range of electives—including marketing, worksite learning, career choices, and psychology, in addition to drama—to both middle and high school students.

What really sets Blaire apart, though, is her approach to online education. When schools switched to remote instruction in March 2020 because of the COVID-19 pandemic, Blaire quickly realized that the existing curriculum didn’t work. It just wasn’t engaging enough without the face-to-face interaction. At the time, her school district was doing fully synchronous instruction. Teachers did live instruction, students could ask questions, and classes operated on the same schedule as before. Still, her students struggled to connect with the material from their homes.

So, she helped develop a new curriculum that worked in an online setting and innovated new techniques to keep her students engaged.

Blaire created new materials and lesson plans that resonated more with Auburn students, 76 percent of whom are people of color—including a new social justice curriculum aimed at helping her kids become more active and informed citizens. Homeroom became a structured social period where students could get to know their teacher and each other, since the normal opportunities to connect—over lunch, or in the hallway between classes—aren’t available in online instruction. The chat function was used constantly throughout her classes, with Blaire checking in to make sure students were engaged and the kids asking (and answering!) questions about the material.

“It gave me this moment to dismantle my curriculum and build it back up with my community in mind, which is such a gift,” Blaire told me. “I found that creative challenge incredibly fulfilling, and it gave me a chance to, I think, become a better teacher.”

The work that Blaire and her colleagues did was eventually spun off into Auburn Online School. Although schools reopened in Washington in 2021 and many students returned in-person, a lot of students in her district continued to opt for remote instruction. Many of them lived in intergenerational households, with older family members who were at risk of becoming seriously ill from COVID-19. Auburn Online gave them a safe, high-quality option for continuing their education.

The Gates Foundation supported a lot of schools that offered this kind of support during the pandemic, so I wasn’t surprised to hear that some students continued to learn remotely to keep their loved ones safe. But what stunned me was how many kids wanted to stick with online instruction for reasons that had nothing to do with the pandemic.

Although many students struggled with the transition to online learning and lack of face-to-face interaction with their teachers and peers, Blaire found that a number of her kids not only adapted but thrived. Some needed extra flexibility so they could work a job or keep up with other responsibilities. Others benefited from having greater control of their learning environments. For example, they could focus much better in the comparative quiet of their own homes, or they had less anxiety when they could answer a question in a chat rather than by raising their hands in front of the whole class.

It blew my mind to learn that fully remote instruction works better for some students. Like many people, I’ve always thought of it as a necessary obstacle to overcome in times of necessity. But Blaire sees it as a tremendous opportunity for some families—and as a powerful tool for driving equity.

I was especially fascinated to hear how she teaches drama. I didn’t think it was a class that would lend itself well to online instruction, but Blaire convinced me otherwise.

“One of the things that is really fun about teaching drama online is that it gives students the space to explore and try things out in ways they might not with all eyes on them in a classroom,” she told me. For example, Blaire sets her students up in breakout rooms, where they can practice in small groups or with her. When it comes time to perform a monologue, they record it—and if they don’t like their performance, they just try it again until they have a version they’re comfortable with other people seeing.

“Some of my students might not have taken a drama class,” she says. “But when you release some of that immediate pressure of performing, you give them permission to be creative in ways they haven’t explored before.”

Blaire is clear that online education isn’t the right fit for everyone. But she’s a firm believer that families deserve it as an option.

Because she is such a big thinker about how technology can help students, I couldn’t resist the opportunity to ask her what she thinks about AI. Blaire is excited about how AI tools will help her better track her students’ progress and provide them with personalized tutors—two use cases I recently saw firsthand in Newark, NJ.

She hopes that teachers are given adequate training on using AI, especially given the biases it can reinforce. Blaire told me about a technology showcase she recently attended. The facilitator was showing off how AI can help teachers save time and asked it to put together a top ten list of recommended reading material for middle schoolers. Every author on the list was white, and almost all of them were men.

This is a solvable problem. AI can be programmed to be more representative and thoughtful in its answers—but it’s going to require input from brilliant teachers like Blaire, who understand the potential and limits of technology in the classroom.

“Online learning creates an opportunity for teachers to be a little bit fearless,” Blaire says. “It’s an opportunity to examine your students, examine your community, and then put it in the forefront of how you’re going to move forward. It’s exciting to try something new, be innovative, and disrupt the norm.”

I couldn’t agree more.

I'll never forget the moment I learned that my dad had Alzheimer's disease. I felt so powerless and scared. Yet, like a lot of people who get this news, I couldn’t help but have hope that a breakthrough would come.

For a long time and for so many families, that hope was unfounded. (We lost my dad to the disease in 2020.) But now, finally, things are changing. We are entering a golden age of Alzheimer's research. Our knowledge of how the human brain works is growing at a tremendous rate, and it’s revolutionizing how scientists approach saving lives.

When I first got involved with Alzheimer’s back in 2017, my expectation for what we would achieve was very modest. A number of high-profile trials for new drugs had failed, and the process for diagnosing someone—either a PET scan or a spinal tap—was costly and time-consuming. The problem was scale: not enough people diagnosed early enough, not enough people in clinical trials, not enough data sharing to learn more.

I thought the research field could do a bit better if it had more resources, but I’m completely blown away by just how much it’s improved. The progress we’ve made is amazing to me. Just look at this list of milestones from the last couple years:

• For the first time, we have simple blood tests that tell you whether you have Alzheimer’s.
• Because of these tests, enrollment in clinical trials is beginning to accelerate. Researchers used to be able to screen only one or two potential patients every day. Now they can screen hundreds. This means new treatments could arrive sooner.
• The FDA approved the first two treatments proven to modestly slow the progression of the disease, and preliminary data indicate they might be dramatically more impactful when given early in the progression.

This progress can’t come quickly enough. In 2017, 5.5 million people in the U.S. were living with the disease. Today, that number has ballooned to an estimated 7.4 million. The good news is that our understanding of the disease is improving rapidly, and I expect to see plenty more breakthroughs in the months and years ahead.

Research continues into next generation treatments that could be twice as effective as the current options, or even better. I’m closely watching a clinical trial that’s looking at whether donanemab, one of the new drugs currently available, could not only slow down the progression of the disease but significantly delay its onset or even prevent it altogether. We should get the results either late this year or early next year, and if they’re positive, it’ll completely change the game.

Meanwhile, the diagnostics are continuing to improve. Today, tests can tell you whether you currently have Alzheimer’s. In the next year or two, we should know whether it’s possible to determine if someone will get Alzheimer’s in the future. The better the tests continue to get, the more people can enroll in clinical trials. Each breakthrough makes it easier to find the new one.

The key with both drugs and diagnostics will be getting them into the hands of people who need them the most. Right now, if you want to take a blood test, you have to pay for it out of pocket. Here in the U.S., it’d expand access massively if the tests and drugs were covered by Medicare and Medicaid. I hope the Center for Medicare & Medicine Services chooses to cover them soon (especially when you consider that dementia costs the U.S. more than $780 billion every year—including more than $160 billion by Medicare and Medicaid alone).

With these new tools, over the next five to ten years, we might finally start to get the upper hand on this awful disease. And here’s another thing on our side: artificial intelligence. There’s a lot of very cool work being done to diagnose Alzheimer’s by using AI to detect changes in how you speak. I’m particularly excited about how AI’s ability to find meaning in large amounts of data will make research go a lot faster.

Research can be a time-consuming and often tedious business. Something as simple as pulling the data sets you need can take up a huge chunk of your time. Agents like Biomni-AD and Parthenon—the winners of the Alzheimer’s Insights AI Prize—can act like a co-researcher, enabling entire workflows autonomously by pulling permissioned datasets and flagging patterns a human might miss.

AI is also helping scientists write their own code, so they’re able to run regression analyses on their own and test more hypotheses more quickly. Many researchers don’t have access to a biostatistician or a data scientist to help them with this. Now, more people can code on their own, and the stats experts are able to focus their time on supporting the most promising hypotheses.

Platforms like the Global Research and Imaging Platform, or GRIP, are making both data access and availability of AI agents possible at scale. We’ll make more advances in the field if researchers and data scientists can work together to share data and develop algorithms and tools. That’s why one of the big focuses of my Alzheimer’s work has been getting more data into their hands. I worked with a coalition of partners to create the Alzheimer’s Disease Data Initiative, which now has more than 10,000 users from over 125 countries, and the Global Neurodegeneration Proteomics Consortium, which has more than 300 million unique protein measures for scientists to learn from.

I believe that we’ll find the answers to some of our biggest questions in that data over the next two to three years. Why do some people get Alzheimer’s in their 60s while others live to 100 and have healthy brains? Is Alzheimer’s one disease, or can we break it into subtypes? Why do more women get it than men? There’s a lot we still don’t know about the brain, and once we understand more, we’ll see a ton of breakthroughs.

We’ve seen this kind of progress before. There was a time not too long ago when an HIV diagnosis was a death sentence. We didn’t understand the disease, and we had no way to stop it. But once scientists began to unravel the biology, progress accelerated. Today, people with HIV can live long, healthy lives. I’m optimistic that, one day, we’ll be able to talk about Alzheimer’s disease the same way.

Father’s Day without my dad never gets easier. Although he is on my mind every day, I always find myself thinking about him even more often this time of year.

My dad was a giant in every sense of the word. More than anyone else, he shaped the values of the Gates Foundation, and everything we have accomplished is a testament to his vision of a better world. Sadly, we lost my dad five years ago to Alzheimer’s disease. It was a brutal experience, watching my brilliant, loving father go downhill and disappear.

In the years since his passing, I’ve met far too many people who had similar experiences with their own loved ones. More than 7 million people in the United States are currently living with Alzheimer’s disease. That means about 1 out of every 9 people over the age of 65 have it. As life expectancies continue to go up, those numbers will only increase.

But here’s the good news: We are making massive progress in the fight against Alzheimer’s and other related dementias.

I saw some of the reasons for optimism firsthand during a visit to Indiana last year. I met with the team at Indiana University’s School of Medicine in Indianapolis—where they have an incredible center that is doing lots of leading-edge neuroscience—and took a super cool tour of their biomarker labs. I also got the opportunity to look under the hood of new automated machines that will soon be running diagnostics around the world. It’s an exciting time in a challenging space.

During my visit, I learned more about the latest big breakthrough in Alzheimer’s R&D: blood-based diagnostic tests. A number of different companies have approaches in the pipeline, but each of them works in roughly the same way by detecting the ratio of amyloid plaques in the brain. I’m optimistic that these tests will be a gamechanger. Here in the U.S., this work reached a huge milestone last month: The FDA approved the first blood-based test for patients 55 years and older.

Until recently, the only way to confirm a suspected Alzheimer’s diagnosis was to get either a PET scan or a spinal tap. Neither were the kind of test a doctor would order unless you were showing clear signs of decline. But catching Alzheimer’s early is key. We now know that the disease begins 15-20 years before you start to see any signs. A simple, accurate, and easy-to-run blood test might one day make routine screening possible, identifying patients long before they experience cognitive decline.

When I talk to people about the promise of these new diagnostics, I’m often asked, “What is the point of getting diagnosed if I can’t do anything about it?”

It’s a fair question—but soon it will be moot. The FDA has approved two drugs for the treatment of Alzheimer’s. Both have proven to modestly slow down the progression of the disease, but what I’m really excited about is their potential when paired with an early diagnostic. My main takeaway from my visit to Indiana is that these treatments could be drastically more impactful than I initially thought when given early in the disease’s progression.

Phase III clinical trials are underway now to prove just how transformative these drugs are for people with presymptomatic Alzheimer’s, and we could see results as soon as 2026. Until then, the drugs will continue to help patients who are already showing cognitive decline.

I’m also optimistic that researchers will continue to improve current treatments and develop new drugs. This will require running lots of clinical trials. Without a simple diagnostic test, it is often difficult to find enough eligible patients. In some cases, it takes even longer to enroll participants—as long as three years!—than to conduct the study. My hope is that the new blood tests will get the recruitment time down to less than a year.

All of this progress hinges, of course, on continued funding for Alzheimer’s research. Some of the biggest breakthroughs to date were supported by federal grants, like the discovery of the connection between amyloid proteins and the disease. This isn’t unusual: Medical R&D often relies on government funding to support projects that explore foundational science or aren’t commercially viable yet.

We are on the cusp of turning the tide against dementia—which makes this an especially bad time to pull back on research. Recent cuts to the National Institutes of Health and other government institutions threaten to stop progress in its tracks, and no individual or private organization can fill the gap.

This is the moment to spend more money on research, not less. Right now, all over the world, researchers are collecting data about Alzheimer’s disease. New tools are making it easier for them to share information and work together. As a result, the quest to stop Alzheimer’s has never had more momentum. For my part, I worked with a coalition of partners to create the Alzheimer’s Disease Data Initiative and the Global Research and Imaging Platform, and I am proud to support organizations like the ADDF's Diagnostics Accelerator and Part the Cloud. All of these efforts simplify how researchers and data scientists work together to share data and develop algorithms and tools in order to make advances in the field.

There is still a huge amount of work to be done—like deepening our understanding of the disease’s pathology and developing even better diagnostics. But I am blown away by how much we have learned about Alzheimer’s over the last couple of years.

When we lost my dad, an Alzheimer’s diagnosis was a death sentence. Just five years later, that is finally starting to change. I cannot help but be filled with a sense of hope when I think of all the progress being made on Alzheimer’s, even with so many challenges happening around the world. We are closer than ever before to a world where no one has to watch someone they love suffer from this awful disease.

Can Alzheimer’s disease be funny? I was skeptical, especially given the devastating experience my family had watching my dad suffer from it. So, I asked two experts in using humor to raise awareness—Seth Rogen and Lauren Miller Rogen—to help me see the light. We had a great conversation about their organization Hilarity for Charity, hope for the future of Alzheimer’s research, the importance of a good night’s sleep, and why Seth started a cannabis lifestyle company. 

This month marks one year since we lost my dad. It’s hard to believe that he’s already missed a full cycle of birthdays, holidays, and family get-togethers. My family is slowly learning how to adjust to life without him, although I don’t think things will ever feel normal again. I miss him every day.

My dad died from Alzheimer’s disease, which means that my family’s grief is far from unique. More people die from Alzheimer’s every year than from breast cancer and prostate cancer combined, and millions are suffering from the disease. Today, one out of every nine people aged 65 or older has Alzheimer’s disease. Too many families are being forced to watch their loved ones go downhill and disappear. It’s a brutal way to lose someone, and right now, there’s no way to stop or even slow down the decline.

I’ve written a lot on this blog about why I’m optimistic that new breakthroughs may someday soon let us substantially alter the course of the disease. One of the areas where we’ve seen the most progress over the past couple years is diagnostics.

The current process for diagnosing Alzheimer’s is a huge hurdle standing in the way of a breakthrough. If we’re going to find a game-changing treatment, we will need to test many different hypotheses, which would mean we need to conduct lots of clinical trials. That requires recruiting a lot of participants early enough in their disease that a drug might make a difference. But patients have to show signs of cognitive decline before they know to get tested—which means that their Alzheimer’s is already quite advanced—so many potential volunteers aren’t eligible. We need a cheap, non-invasive way to diagnose patients early before their symptoms get too bad.

The good news is that there are a number of promising new diagnostic tests in the pipeline. I partnered with the Alzheimer’s Drug Discovery Foundation to develop a philanthropic fund called the Diagnostics Accelerator several years ago with the hope that it would kickstart a bunch of new research. We were then joined by Jeff Bezos, MacKenzie Scott, the Dolby family, and several others to expand the effort. The first round of funding is expected to be completed by the end of the year, and many of the award recipients are already making terrific progress.

Some are working on diagnostics that may be available soon, like the simple blood test being developed at the University of Gothenburg in Sweden. Blood tests are the gold standard for diagnosing many diseases for a reason: they’re easy to administer and can be inexpensive to analyze. The test developed at Gothenburg looks for several indicators in the blood, including the presence of a protein called amyloid that can cause plaques in the brain. Samples are run through a common type of diagnostic platform developed by Roche, which means they can be analyzed at most labs.

Having an accessible blood test for Alzheimer’s would be huge. Many of us get our blood drawn once a year during our physical, and it’s easy to imagine a future where your results tell you how your brain is doing, just like how you currently get updates on the state of your heart. I’m hopeful this test will be available within the next year or two.

Other diagnostics in the pipeline use more unexpected methods to detect Alzheimer’s, like an eye test. Cecilia Lee—a researcher at the University of Washington here in Seattle—believes that your retina can provide a window into the brain. In 2018, she published a study showing that having an eye condition like glaucoma or macular degeneration doubles your risk for Alzheimer’s.

Ever since, she’s been looking for ways to use this link to diagnose Alzheimer’s. Cecilia and her colleagues are exploring different ways to scan your eyes for early signs of Alzheimer’s, including by using artificial intelligence to spot tiny irregularities that a human could never find. The UW team isn’t the only group hoping that the eyes are the key to a better diagnostic. Several companies including RetiSpec, Neurovision Imaging, and Optina Diagnostics are using new imaging techniques to look for amyloid plaques. We’re still years away from your annual eye exam including any test for Alzheimer’s, but I’m excited to keep following the research.

All of the tests I’ve mentioned require a trained medical professional and specialized equipment—but what if all you needed to assess your brain health was your smartphone? Several companies are working on highly sophisticated apps that might one day become diagnostics that are accessible to anyone with a phone or tablet. They have tremendous potential, although it’s too soon to tell whether any of them will pan out.

Cogstate is working on a test that looks like a series of mobile games. Each one evaluates a different function of your brain, like your ability to recognize emotions or focus on a task. A different company called Altoida is developing an app for your phone or tablet that uses augmented reality games to assess your cognitive abilities. (If you’ve ever played Pokemon Go, you’ve used AR.) If you score below a certain threshold on either test, your doctor could then order another diagnostic—like a blood test—to confirm whether you have the disease.

Nearly all of the tests I’ve mentioned are being supported by the Diagnostics Accelerator. The fund has invested in 25 candidates to date, and I’m hopeful that we have at least one game changer in the group. The Diagnostics Accelerator is also doing great work to make more samples and data available to researchers, which will hopefully speed up the time it takes to find a breakthrough.

If we want to stop Alzheimer’s, one of the biggest things we need to develop is a reliable, affordable, and accessible diagnostic. I think we’re close to having one, and the developments we’ve seen over the past couple years make me more optimistic than ever that we can one day stop Alzheimer’s. I can’t wait to see what new progress is unlocked thanks to better tests.

My family loves to do jigsaw puzzles. It’s one of our favorite activities to do together, especially when we’re on vacation. There is something so satisfying about everyone working as a team to put down piece after piece until finally the whole thing is done.

In a lot of ways, the fight against Alzheimer’s disease reminds me of doing a puzzle. Your goal is to see the whole picture, so that you can understand the disease well enough to better diagnose and treat it. But in order to see the complete picture, you need to figure out how all of the pieces fit together.

Right now, all over the world, researchers are collecting data about Alzheimer’s disease. Some of these scientists are working on drug trials aimed at finding a way to stop the disease’s progression. Others are studying how our brain works, or how it changes as we age. In each case, they’re learning new things about the disease.

But until recently, Alzheimer’s researchers often had to jump through a lot of hoops to share their data—to see if and how the puzzle pieces fit together. There are a few reasons for this. For one thing, there is a lot of confusion about what information you can and can’t share because of patient privacy. Often there weren’t easily available tools and technologies to facilitate broad data-sharing and access. In addition, pharmaceutical companies invest a lot of money into clinical trials, and often they aren’t eager for their competitors to benefit from that investment, especially when the programs are still ongoing.

Unfortunately, this siloed approach to research data hasn’t yielded great results. We have only made incremental progress in therapeutics since the late 1990s. There’s a lot that we still don’t know about Alzheimer’s, including what part of the brain breaks down first and how or when you should intervene. But I’m hopeful that will change soon thanks in part to the Alzheimer’s Disease Data Initiative, or ADDI.

I worked with a coalition of partners to create ADDI, because we believe that more data sharing will accelerate progress towards an Alzheimer’s breakthrough. To make this happen, ADDI created the Alzheimer’s Disease workbench.

This workbench hosts an open, global, and easy-to-use set of tools and resources. The goal is to simplify how researchers and data scientists around the world work together and share data, code, and knowledge in order to make advances in the field.

Instead of having to navigate dozens of individual databases, scientists will be able to access and upload information to a patient database from around the world. The workbench also facilitates access to datasets from failed drug trials, since many pharmaceutical companies have decided that the benefits of sharing their data outweigh the risks. And all the data is in compliance with privacy laws, so researchers don’t have to worry about compromising anyone’s personal information.

I’m optimistic that this will make a real difference in Alzheimer’s research, because there are many examples where we’ve made progress on diseases after bringing together large amounts of data. One is malnutrition. Several years ago, our foundation launched an initiative to pool information about childhood growth to try to see when exactly a child who ends up stunted starts falling behind.

That information produced some fascinating insights. For example, we learned that, in South Asia, weather cycles play a huge role in whether a child recovers from a period where he or she doesn’t get enough to eat. If you’re born during monsoon season—when food can be harder to come by—you still have a decent shot at getting back on a normal growth curve eventually. But if your mother was in her third trimester during monsoon season, you’re much less likely to get back on track. This insight has implications for how we address malnutrition in that region, and we would have never discovered it without pooling lots of different data sources.

The Alzheimer’s workbench will finally be available to scientists this month after a year and a half in development. (If you work in data science or Alzheimer’s research, or are just a curious researcher, you can explore the AD Workbench here.) But even though the workbench is only now becoming broadly available, we’re already seeing huge benefits from it—just not on the disease we expected.

In the early days of the COVID-19 pandemic, our foundation decided to use the Alzheimer’s workbench framework to create a platform for sharing information on the novel coronavirus. This platform is letting scientists from all around the world collaborate to understand more about the virus and its impacts. Each insight we gain about the virus moves us closer to the end of the pandemic, just as each insight about Alzheimer’s moves us closer to a breakthrough.

I want to be clear: data alone is not going to find the miracle treatment or the diagnostic we need to stop Alzheimer’s (or COVID-19). But what it can do is let us test hypotheses and point us in the right direction.

Nearly forty million people around the world have Alzheimer’s or dementia today. We have no way to stop or even slow the disease at this point. I lost my dad to Alzheimer’s two months ago, and I wouldn’t wish that experience on anyone. My hope is that the data sharing facilitated by ADDI will move us closer to a world where no one has to watch someone they love suffer from this awful disease.