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.

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. 

As a child growing up in the 1980s on a small farm in western Kenya, Wendo Aszed found it difficult to make good friends. She finally found a confidant when she was in her twenties and working at a bank in the city of Nakuru, Kenya. Her friend was a smart, kind man who became someone “I would die for,” Wendo says.

In 2007, he told her that he had just tested positive for HIV. Wendo immediately got to work trying to help him get lifesaving anti-retroviral medication (ARVs). But by that time, her friend had already contracted meningitis, and he died less than a month later. “When you have the kind of grief I felt, you might grow around it, like a tree grows around a rock,” she explains. “But you never, ever lose it.”

In the hope of saving others from the same fate, Wendo started visiting nearby villages and engaging women in wide-ranging conversations about their health and lives. Eventually she was able to build enough trust to offer gentle advice on how they might find help for addressing their biggest challenges—from HIV infection to the loss of young children at the hands of abusers in the community.

Wendo was so passionate about this mission that, in 2009, she quit her financially secure job at the bank and began helping the women full time. “I had no formal training for this, and I had absolutely no savings to do it, but I just had to do it,” she recalls. She recruited a group of mentors from the local nonprofit community and set up an organization, which she called Dandelion Africa—a tribute to the resilience of women thriving in difficult environments. Dandelion Africa is how Wendo grew around her grief.

The first two years of operations almost broke her. She had no grant money or other resources to pay herself or anyone else. “Ironically, I felt selfish doing what I was doing,” she says. “I knew I was helping these women, but our family was going through hell. My husband did his best to support us with his earnings as a farm manager, but we barely had enough to pay school fees for our children.”

Just when Wendo was about to give up, the Kenyan government gave Dandelion Africa its first grant—a total of $3,500. The grant allowed Dandelion to provide HIV testing and counseling to almost everyone in one community. Through this work, Wendo learned just how many people living with HIV had no medical or psychological support. She saw that she had to go upstream—that is, not just ensure that women could get ARVs but also help change the economic and social conditions that were leading to such high rates of transmission.

Even as she started to line up the resources to go upstream, Wendo faced significant obstacles because of her gender. Once, when she sat down with a local official as she was organizing a government-funded free health clinic for his community, he started to tell her that she would have to pay for the doctors’ and nurses’ gasoline, the staff lunches, and washing the uniforms. When she resisted, he stood up and said, “In my tribe, when a woman speaks like that to a man, we slap her.” Wendo replied: “In my tribe, when a man hits a woman, we kill him.” The official sat down and said, “Okay, let’s plan this clinic.”

Over the subsequent decade, Dandelion built an all-Kenyan staff and a network of more than 200 volunteers, providing comprehensive health, economic, and educational services across a large swath of rural Kenya. Today, Dandelion Africa provides one of the best examples I’ve seen of community-led problem solving.

She and her team built—partly with their own hands—the all-hours Dandelion Medical Centre. The facility, which opened three years ago, is now driving down maternal mortality, HIV transmission from mothers to their babies, and vaccine-preventable diseases in a region where families previously had little access to even the most basic care. “When I first started the organization, I was barely staying alive,” Wendo says. “To come full circle and open a medical center that ensures every woman in the region can get quality care, that was just overwhelming to me. I just wish my best friend could have been with us at the opening.”

Dandelion Africa is also taking primary care directly to families. Its nurses hop on motorbikes and travel to homes, where they provide immunization, HIV testing, and other services. Dandelion Africa has also helped thousands of women and girls access contraceptives and sanitary supplies for the first time.

Wendo’s organization has also launched efforts to empower women and girls. For example, it helps women access small loans for starting their own businesses. It helps women adopt profitable farming techniques. And Wendo’s 22-year-old son helped create a successful effort to engage men and boys as advocates for women and girls. “When I see men becoming champions fighting FGM and whole villages saying no to FGM because they see how it harms the whole community, I know we’re doing something right,” Wendo says.

Counterintuitively, Wendo often finds it even more difficult to change women’s perceptions than men’s. “Sometimes, the women simply can’t imagine what it would be like not to be beaten by their husbands,” she says. “But we’ve learned how to reach them. We share stories that help them envision a different path.”

While the name Dandelion Africa suggests that Wendo has aspirations to expand in other parts of the continent, that is not the case. “We are going to stay in the hardest parts of Kenya, where no one else wants to work,” she explains. To achieve greater scale, she is working to cultivate 50 more dandelion-type leaders around the country.

Although finding 50 others with Wendo’s drive will not be easy, I’m optimistic that this tough, resilient leader will succeed.

Last year, at an event in New York, I learned about an impressive woman whose story I want to share with you. Her name is Cacilda Fumo, she lives in Mozambique, and every year she helps save hundreds of lives—by reminding them they are not alone.

Mozambique has one of the highest HIV infection rates in the world. More than 1.6 million people—10 percent of the adult population—are living with HIV.

Cacilda was diagnosed with HIV in 2002. “When I first learned about it, I thought I would die,” she recalls. “I used to wake up early morning and check if I am alive or not.”

But then she started meeting other people living with HIV, and as their numbers grew so did her strength and her belief she would live. Cacilda was one of the first in Maputo to be open about her status. She started wearing a t-shirt emblazoned with a logo that reads: “HIV POSITIVE.”

At times, people rejected her because of her status. Many more in her community, however, admired her for her courage, helping her create an even larger circle of friends and supporters. They met every week, praying together, cooking together, and sharing their stories. Eventually, the group had about one hundred people, many of them receiving life-saving anti-retroviral treatment. Cacilda emerged as their leader.

About the same time, Mozambique’s Ministry of Health was struggling to improve the delivery of anti-retroviral treatment. While the program was successful in putting thousands of patients on treatment for the first time, medical staff were overburdened with caseloads. People on HIV treatment often walked miles to reach their clinic and waited in long lines to get care. Every year, about 30 percent of HIV patients dropped off their life-saving treatment.

Working with Doctors Without Borders, the government of Mozambique decided to try a new approach to simplify care to help keep more people on treatment. They started organizing small peer support groups for people on HIV treatment. The idea was simple. Make treatment easier by putting more control into the hands of the patients. A representative from each patient group could pick up all the drugs for the group each month, saving the rest of the group the hassle of going to the clinic. Members of the groups, known as Community antiretroviral therapy (ART) Groups or CAGs, would also support one another to ensure they were all staying on their treatment.

When the program reached Maputo, Cacilda was ready to join. She helped organize dozens of support groups from her network. Then she went one step further. She kept track of the groups, checking whether members were attending their meetings and taking their treatment. If someone fell off treatment, she took upon herself to locate them and find out what was wrong.

“We help people feel strong knowing they are not alone,” she says.

Some patients who stop treatment are addicted to alcohol and forget to take their treatment, she says. Some don’t understand how the treatment works and the stop taking their medication as soon as they feel better. Others get busy with their jobs and drift away.

Whatever the reason, Cacilda warns them of the dangers of stopping treatment and encourages them to restart. Her efforts to bring back residents of Maputo to treatment has become nearly full-time work. Most days residents of Maputo see Cacilda traveling on foot—which is remarkable because due to a childhood injury she uses crutches—through the dirty alleyways and crowded markets in search of people who have stopped treatment. She doesn’t give up until she finds them.

Cacilda’s persistence pays off—in lives saved. Cacilda estimates that she tracks down about 500 people every year and encourages them to resume their treatment.

That’s a remarkable achievement—one that proves how much difference one life can make in the world. 

In a few days, I’ll be traveling to India—my third visit in three years. India is a place where big challenges meet even bigger ambitions, and where innovation is transforming lives at an incredible scale. Every time I’m there, I see firsthand how much progress is being made in public health, agriculture, and technology. And I come away with new ideas, because India is full of smart, ambitious people tackling some of the world’s hardest problems in creative ways.

This visit will also be significant because—as we mark our 25^th anniversary—the Gates Foundation’s Board of Trustees is meeting in the Global South for the first time. India is the right place for this milestone. The foundation has been working in the country for more than two decades, partnering with the government, researchers, and entrepreneurs to improve health and development. Today, India is home to some of the most impactful programs we’ve contributed to, from disease eradication and sanitation to women’s empowerment and digital financial services. This trip will give me a chance to see what’s working, what’s changing, and what’s next—for India and the foundation.

India’s track record in public health shows what’s possible. When I visited in 2011, it was one of the last places in the world still fighting polio. But that year, after relentless effort, India recorded its last case—and it’s remained polio-free ever since. Avahan, the HIV prevention program launched by the Gates Foundation two decades ago, is another success story. It pioneered a community-led approach to reduce infection rates that complemented the government’s efforts in high-prevalence states; eventually, management of the program transitioned to the Indian government, becoming part of the country’s broader health strategy.

That same model—leveraging local leadership, innovative solutions and data-driven insights—is now driving India’s fight against tuberculosis. The country has the world’s highest TB burden, but its investment in new diagnostics, AI-powered detection tools, and improved treatment strategies is accelerating progress toward elimination.

India’s success in childhood immunization is another reason I’m eager to return and learn more. Over the past several years, the country has scaled up routine vaccination programs, ensuring every major childhood vaccine is available. It has also used digital dashboards to track vaccine coverage, monitor cold storage, and improve maternal and child healthcare. These efforts have helped drive down mortality rates and create a stronger health system that can respond to new challenges.

India’s global health leadership is also transforming how the country approaches diagnostics and treatment for infectious diseases. As a result, it’s become a leader in low-cost vaccine manufacturing, ensuring that life-saving vaccines are available around the world. Indian companies are also tackling another critical challenge: making diagnostics more affordable. One effort I’m following closely is the push to make a saliva-based TB test for under $2, which could help millions of people in India and globally detect the disease earlier and get treatment faster.

Beyond health, India is also at the forefront of digital transformation. I’ve written before about how digital public infrastructure (DPI)—like Aadhaar and India’s digital payments system—has made it easier for millions of people to access banking, healthcare, and government services. Now, India is using AI-powered DPI tools to help rural health workers improve early disease detection, optimize pregnancy care, and manage patient data more effectively.

AI is also transforming agriculture across the country. When I was in Odisha last year, I saw farmers using AI-powered tools to predict weather patterns, choose crops, and reduce disease risks. I’m looking forward to seeing how much better those tools have gotten in the short time since.

What makes India’s progress so transformative, though, is that it doesn’t just benefit India. During India’s G20 Presidency in 2023, Prime Minister Modi declared his intent to make Indian innovations and know-how available to solve development problems globally. And that’s exactly what is happening. The solutions being developed there, from vaccine manufacturing to AI-powered diagnostics, are being shared with the world. Indian companies are making TB tests that could be game-changing across Africa. They’re developing AI models that could help farmers across Asia. And they’re proving that digital technology can make healthcare work better for everyone, especially the most vulnerable.

At the Gates Foundation, we tackle tough problems by working in close partnership with the people and governments most affected by them. India has been an incredible partner in this work because of the country’s deep expertise and willingness to develop and scale new ideas. The challenges remain: eliminating TB, improving nutrition, expanding access to AI-driven health and development services. But India has shown time and again that progress happens when innovation, local leadership, and investment come together.

That’s why I’m so excited for this trip. I’ll be meeting with government leaders, scientists, and philanthropists who are shaping the future of health and development in India. I’ll be visiting innovators who are working on solutions that could help people in India and around the world. And I’ll get to see how the foundation’s work fits into this bigger story—and how we can continue to support Indian-led efforts to improve lives.

I always leave India inspired. I know this trip will be no different.

I was scrolling Reddit recently when I saw a video of a mosquito trying and failing to suck someone’s blood. Some of the replies were pretty funny, but I noticed that most of them were just some form of “How do I get this person’s superpower?” It was a great reminder of how universally hated these bloodsuckers are.

But I have good news—for Reddit users and everyone else: Real progress has been made in the fight against mosquitoes and specifically against malaria, the deadliest disease they carry. And I believe we’ll soon have the transformational tools needed to end malaria entirely.

Eradication is a goal Melinda and I set back in 2007, when we stood before a group of global health leaders and called for something many considered impossible: wiping malaria out completely from every country. And until that happened, our goal was—and is—to save as many lives as possible by maximizing the impact of the tools we already have. Eradicating the disease wasn't a new idea; the World Health Organization had made a similar declaration back in 1955. But that earlier campaign, while successful in many wealthier parts of the world, had fallen short across Africa, Asia, the Middle East, Eastern Europe, Central and South America, the Caribbean, and Oceania. Despite half a century of effort, malaria was still infecting up to half a billion people—and claiming a million lives—annually.

Today, the landscape has changed dramatically. In 2022—the last year we have data on—there were 249 million cases worldwide and 608,000 deaths. Those are staggering numbers, but they’re also improvements from where the world was back in 2007. Since then, 17 additional countries have been declared malaria-free by the World Health Organization. Outside of Africa, deaths from the disease have mostly been eliminated.

Can computers see? The answer is complicated. I've been following the field of computer vision for decades—ever since Paul Allen and I started dreaming about what you could do with a personal computer—and we're only now reaching the point where they can really understand visual inputs. We still have a long way to go, but the ability of computers to see things is already revolutionizing many parts of our lives. It makes autonomous vehicles possible. It’s used to read x-rays quickly and accurately, and it’s what allows a mobile phone to translate street signs from one language to another.

Lately I’ve been especially enthused about a different application (and one my teenage self never would’ve imagined caring about): scanning pictures of mosquitoes.

Mosquitoes are responsible for spreading malaria, which kills more than 600,000 people every year and is a major focus of the Gates Foundation’s health work. Although scientists have learned a lot about them in the past few decades, one challenge has been especially stubborn: telling one mosquito from another. There are around 3,500 different species of them, and many look alike. Even a highly trained entomologist has to examine one for several minutes under a microscope to identify it accurately.

Why do we care about mosquito species? Most importantly, because different species can carry different diseases, and some don’t carry any diseases at all. (The ones that carry malaria belong to the genus Anopheles.) There are other differences too: Some bite people indoors, while others feed outdoors. Some dine at dusk while others take their meals during the day. And only females bite—the blood gives them the energy needed to lay eggs.

All this variation means we need different tools for different mosquitoes. For example, indoor insecticides and bednets work well against species that primarily bite indoors. But for the ones that mainly live and feed outside, you’ll need to take other steps too, such as eliminating the outdoor spaces where they breed.

Fortunately, some novel uses of computer vision are supercharging the process of identification. They’re not only helping us know our opponent, they’re helping us target its weak spots, save more lives, and move even closer to eradicating malaria.

One of the most exciting innovations is called VectorCam—an app that lets someone with minimal training identify mosquito species in a matter of seconds.

VectorCam was developed by Dr. Soumya Acharya and his team of bioengineers at Johns Hopkins University, with support from Uganda’s malaria control program, Makerere University, and the Gates Foundation. Using a smartphone, the VectorCam app, and an inexpensive lens attached to the phone, you simply take a picture of a mosquito and get it identified right away. The app can distinguish among the different species that transmit malaria. It can also determine the sex of the mosquito and, if the insect is a female, whether it has recently fed on blood or developed eggs. And with further refinement, VectorCam could identify species that carry other diseases, like dengue and Zika.

Almost thirty years ago, I wrote a book called The Road Ahead, about the transformative potential of the internet and other new digital technologies. Back then, I envisioned a world where online payments and e-government would change how we interact with money, services, and each other. Today, much of that has become a reality, in part due to the development of digital public infrastructure. In my recent travels around the world, I’ve seen up close how DPI is revolutionizing the way entire nations serve their people, respond to crises, and grow their economies. And at the Gates Foundation, we see it as an important part of our efforts to help save lives and fight poverty in poor countries.  

There are a few core components that constitute DPI: digital ID systems that securely prove who you are, payment systems that move money instantly and cheaply, and data exchange platforms that allow different services to work together seamlessly. These systems and platforms are to the digital world what roads, bridges, and power lines are to the physical one—an underlying structure that connects people, data, and money online. Strong DPI can propel a country forward by making it easier for people to access essential services, participate in the formal economy, and improve their lives. On the flip side, DPI that is poorly implemented (or simply non-existent) can slow a country’s development and perpetuate inefficiencies and inequities.  

In the 21^st century, digital public infrastructure is proving to be as important for progress as its brick-and-mortar predecessors—and the effects have been impressive around the world, wherever it’s been embraced.

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.

Hello from Texas! I’m in Corpus Christi and Houston this week to meet with some of the remarkable innovators building America’s clean energy future. It’s going to be a great trip.

If you want to see what the cutting edge of next-gen clean energy innovation looks like, it’d be hard to find a place better than Texas. Amazing companies are breaking ground not just here in Southeast Texas but across the state. Each one represents a huge boon for the local economy, America’s energy security, and the fight against climate change.

The world is undergoing an energy transition right now, fueled by the development and deployment of new clean energy technologies. The pace of innovation at the heart of this transition is happening faster than many people (including me!) dared hope. The progress makes me optimistic about the future—and excited about the role that American communities will play, especially in places like Texas. Breakthrough Energy and I have invested more than $130 million into Texas-based entrepreneurs, institutions, and projects. It’s a big bet, but it’s one I’m confident in.

Why? Because of the people. Nearly half a million Texans work in the oil and gas industry, and their skills are directly transferrable to next-generation industries. This workforce will help form the backbone of the world’s new clean energy economy, and it will cement Texas’s energy leadership for generations to come.

Many of the companies I’m seeing on this trip already employ or plan to employ oil and gas workers. One of those companies is Infinium, which is working on next-generation clean fuels for trucks, ships, and even planes. I’m visiting their first demonstration plant in Corpus Christi, where they’re turning waste CO2 and renewable energy into electrofuels—or eFuels—for trucks. They’ve already signed a deal with Amazon, and sometime soon, if you live in the area, you might get a delivery supported by Infinium eDiesel.

The key to Infinium’s approach is that their fuels can be dropped into existing engines. That’s huge. It means that companies won’t have to adapt their fleets, removing one of the biggest hurdles to transitioning to a new fuel. I’m especially excited about the work they’re doing on sustainable aviation fuel, or SAF—which could reduce emissions from air travel by as much as 90 percent, according to company estimates. Infinium is in the process of converting an old gas-to-liquid plant in West Texas into a new facility that will increase the company’s capacity for producing eFuels ten-fold. Breakthrough Energy’s Catalyst program has invested in this first-of-its-kind plant, and I can’t wait to see it when it’s done.

Another company I’ll see is Mars Materials. They’re a Breakthrough Energy Fellows project working on a different way to reuse CO2. The company is developing a clever technique for turning captured carbon into one of the key components in carbon fiber, an ultra-light, ultra-strong material that is used in everything from clothing to car frames. (If you’ve never played pickleball with a carbon fiber racket, I recommend trying it—you won’t believe how much power you get with your shots!) The Mars Materials team relocated from California to Texas in part because of the skilled oil and gas talent that they could access in the state, and they aren’t the first Breakthrough Energy company to do that. I’m going to check out their lab, where their scientists are hard at work optimizing the conversion process.

Both of the companies I just mentioned are turning CO2 into useful products. Their business models assume that they’ll have access to lots of carbon. Fortunately for them, Texas is also in the process of becoming a capital for direct air capture. DAC is the process of removing carbon directly from the air. The captured carbon can either be sequestered underground or reused by companies like Infinium and Mars Materials. A recent study found that Texas has the greatest DAC deployment potential in the country and could create as many as 400,000 jobs by 2050.

DAC is the fire extinguisher of clean energy technologies: It’s something you hope you will never need but should have ready if (and when) you do. In an ideal world, we’d adopt clean energy quickly enough that we wouldn’t need to remove carbon from the air. In reality, that hasn’t happened. We already have decades of legacy emissions that we’ll need to clean up, so we need a significant DAC industry.

During my visit, I’ll meet with local business and community leaders involved in the development of a DAC Hub in Kingsville, Texas. The Hub is the brainchild of Occidental’s 1PointFive, and over the next five years, it will bring an estimated 2,500 jobs to the community. I was an early investor in direct air capture technology, and it’s super cool to see it evolve from a concept to real economic opportunity for a local community.

The DAC project has been selected to receive a grant from the Department of Energy as a result of the Bipartisan Infrastructure Law. Having been involved in some of the early discussions of the clean energy bills a couple years ago, I’m amazed to see how much progress has been made since then—and eager to meet with the people moving it forward. The DAC Hubs are a perfect example of how innovation can and should work. Private investors take on risks in developing cutting-edge innovations, which are then scaled up through a mix of public and private investments.

It’s going to be an exciting couple of days. I’m looking forward to catching up with leaders from many of the Breakthrough Energy-supported companies based in the area. I’ll talk about the tremendous potential I see in clean industries at CERAWeek, one of the biggest annual energy conferences in the United States. I’m also going to learn more about the Regional Clean Hydrogen Hub being developed in the area, and I’ll tour Air Liquide’s hydrogen facility in the town of La Porte. Their plant uses steam methane reforming to generate hydrogen fuel for industry, and it will be retrofitted in the coming years to eliminate its emissions. (As I’ve written before, hydrogen will play a key role in the energy transition.)

All the companies I’ll see in Texas this week are at the heart of the energy transition. They’re driving innovation, bringing good jobs to their communities, and boosting the American economy. If you want to catch a glimpse of our country’s clean energy future, you should head on down to the Lone Star State.

Open the newspaper, turn on the TV, or go online, and you’ll find alarming headlines about raging wildfires, devastating storms, and severe droughts. Climate change is staring us in the face, and the evidence is everywhere. What's harder to see, unless you know where to look, is growing evidence that we're making real progress in the fight against it. That's why I'm so excited to be in London this week for the Breakthrough Energy Summit. Here, this progress is on full display, and we’re bringing together global leaders, industry executives, innovators, and investors to accelerate it.

When we launched Breakthrough Energy back in 2015, the Paris Agreement had just been adopted. Nearly every country on earth committed to ambitious emissions cuts in the fight against climate change. But it was clear that meeting these goals would require unprecedented investment from the private sector to drive innovation. It would also require extraordinary collaboration across all sectors to get clean energy ideas out of the lab and into the market affordably and at scale. This work has been Breakthrough Energy's mission from day one.

At the first BE Summit in 2022, I shared updates on the cutting-edge concepts and companies we’re supporting that address the five grand challenges—manufacturing, electricity, agriculture, transportation, and buildings—behind most of the planet’s greenhouse gas emissions. This year, in London, we have much more to share: a portfolio of climate technologies that aren't just theoretical or promising anymore, but proven and ready for the market today.

That's what makes this summit so momentous. In less than a decade, investment has helped turn pipe dreams into a pipeline of transformative solutions. Now, it’s time to invest so those solutions can scale up, deploy, and slash emissions in every sector of the economy.

Manufacturing – 29% of global emissions

Manufacturing—how we make almost everything—is one of the hardest sources of emissions to cut. While the challenges here are complex, the pace of progress has been incredible, and faster than what I hoped when I started Breakthrough, especially in cement and steel, which each contribute around 10 percent of all global emissions. CarbonCure has pioneered a way to inject waste carbon into fresh concrete, the end product cement is used for—making the second-most consumed material on earth much greener. Their retrofits of existing facilities, deployed at over 800 locations worldwide, have prevented nearly half a million tons of CO2 from entering the atmosphere.

Meanwhile, Ecocem’s ACT technology for low-carbon cement was recently approved for full commercial use across Europe—while another of its low-carbon concrete solutions was used in construction for the Athletes’ Village at the upcoming Summer Olympics in Paris. And Boston Metal has nailed the production of “green” steel without coal at scale, and now has a facility up and running in Brazil.

Electricity – 29% of global emissions

Most experts agree that the world’s electricity needs will triple by 2050. And when it comes to climate change, electrification is a key part of the solution. But only if the electricity is green; otherwise, we’re just swapping one source of emissions for another. Until recently, we haven’t had good options for storing electricity at scale, which made it hard to get the most out of intermittent renewable energy sources like wind and solar. Now, Form Energy’s affordable batteries can store this energy for multiple days and make it more reliable. Their West Virginia factory, which is nearing completion, is bringing over 750 jobs to a town whose tin mill recently closed. And TS Conductor’s advanced power lines, already commercially deployed, can double the amount of transmittable power and help maximize our current grid’s efficiency.

Agriculture – 20% of global emissions

What we grow and eat has a huge impact on the climate. But Pivot Bio is lessening that impact with microbial products that allow crops to draw nitrogen from the air, giving farmers something they’ve wanted for a long time: a more reliable and efficient form of fertilizer. Their solutions—which produce less than one percent of the emissions of synthetic fertilizers and need 1,000 times less water—are already being used across five million acres of land to help farmers improve productivity while eliminating emissions. And Rumin8, whose feed supplements have successfully reduced livestock methane emissions by over 90 percent while boosting productivity, demonstrates that we can enjoy beef and dairy without the high environmental costs they're typically associated with. They recently opened a demonstration plant in Australia to showcase the commercial viability of their products.

Transportation – 15% of global emissions

Electric vehicles are the future, but their batteries are made of resources that are both limited and difficult to source responsibly. One solution is recycling—and Redwood Materials has figured out a better way to do it. At their facility in Nevada, the metals found in recycled batteries are refined and then reused in new batteries, all while emitting 40 to 70 percent less than other recycling processes. But recycling alone won’t be enough to meet the growing demand for EVs and electrification more broadly. New supplies will be needed—something KoBold Metals has cracked the code on. They’re using AI to more reliably find minerals and metals that will undergird the energy transition, most recently copper in Zambia.

Long-distance and heavy-duty transportation still have significant technical hurdles to overcome, but there’s impressive progress being made, particularly in aviation and shipping. ZeroAvia, for instance, is developing hydrogen-electric aircraft engines with operations in the U.K. and U.S., and their prototype engines are successfully flying aircraft in early trials.

Buildings – 7% of global emissions

Ensuring that buildings are warm in the winter and cool in the summer takes a lot of energy—and much of it gets wasted by single-pane windows and leaky ducts that let heat and AC slip out. But there are new options to help fix these issues. LuxWall has created ultra-insulating window glass that is so efficient, it performs like a wall you can see through. After years of R&D, their windows are rolling off the production line at their first commercial factory in Michigan; once installed, the windows will cut both costs and emissions. Then there’s Aeroseal, whose innovative polymer technology finds and plugs air leaks in a building’s envelope and ducts and is already commercially deployed.

Carbon Management

To limit global warming, though, it’s not enough to stop emitting greenhouse gases going forward. We also need to manage what’s already been emitted. In Arkansas, Graphyte is turning plant waste into carbon-trapping bricks and burying them underground; if they sequester 50,000 tons of carbon by 2025 as planned, it will be the largest carbon removal project in the world. In California, Heirloom Carbon’s first-in-the-nation commercial Direct Air Capture facility uses limestone forty feet high to absorb carbon from the air like a sponge. The pilot facility is removing 1,000 tons a year already, and they have plans to scale rapidly.

These are just a few of the more than 100 BE-backed companies that are gathered in London this week to showcase their solutions—all addressing the grand challenges, all ready to work, and all proof that the Clean Industrial Revolution is here. (For more on the progress we’ve made and what’s still left to do, see BE’s latest State of the Transition report.)

Now we need to supercharge our support and ramp up our investments. With commitments and capital from governments and industry leaders, we can deploy these solutions and get them to scale. We can drive down the stubborn green premiums that make a lot of clean technologies more expensive than their dirty counterparts (and too expensive for widespread adoption). We can keep the innovation pipeline flowing. We can get much closer to an abundant, affordable, clean energy future.

Thanks to brilliant minds, big ideas, and bold investments, transformative climate tech has arrived. It's here in London. The Breakthrough Energy Summit is where the momentum that’s been building since 2015 meets the marketplace. I can’t wait to talk to everyone here about where we go next. And I’m eager to see how the connections, partnerships, and investments forged over the next few days help this climate tech reach everyone—and help us reach net zero.

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.

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. 

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.

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.