We started the Gates Foundation 25 years ago to save and improve children’s lives. But no one can solve a problem they don’t fully understand. And back in 2000, the world’s understanding of childhood mortality was occasionally inaccurate, often imprecise, and almost always incomplete.

That’s why I believe the breakthrough that transformed our foundation in the two-and-a-half decades since wasn’t a single vaccine or treatment—it was a revolution in the world’s understanding of childhood mortality. Through advances in how researchers collect and analyze global health data, we now know much more about what kills children, where these deaths occur, and why some kids are more vulnerable than others. By putting those insights to work, we’ve been able to save lives.

The first challenge was knowing exactly what was killing children.

Reading the 1993 World Development Report opened my eyes to the scale of the problem: Around 12 million children under the age of five were dying every year, with a staggering disparity between rich and poor countries. But the available data was fragmented and inconsistent. That made it difficult to understand trends or allocate resources effectively.

So the foundation helped create the Institute for Health Metrics and Evaluation at the University of Washington, to give a permanent home to the Global Burden of Disease study—originally developed in the 1990s by researchers at Harvard University and the World Health Organization. We wanted to expand it from a static snapshot of the problem into a regularly updated tool that tracked how diseases impact people around the world. That gave us something the world never had before: a comprehensive—and current—picture of child mortality across every country.

Measuring symptom-based causes of children’s deaths was an important step. But broad disease categories like “diarrhea” or “respiratory infection” didn’t give us enough information to act on. We needed to know which specific pathogens were responsible for the most common and fatal cases. So the Gates Foundation funded two landmark studies to find out.

In 2013, the Global Enteric Multicenter Study, or GEMS, found that rotavirus was causing 20 percent of lethal diarrhea cases in kids. At the time, diarrhea was the second-leading infectious killer of children. While oral rehydration therapy had already helped bring down deaths over previous decades, GEMS helped fast-track the rollout of a more targeted tool—a new rotavirus vaccine—in the hardest-hit countries, in close partnership with Gavi, the Vaccine Alliance.

A year later, the Pneumonia Etiology Research for Child Health study, or PERCH, revealed that respiratory syncytial virus, or RSV, was a much more common cause of severe pneumonia—the leading infectious killer of kids around the world—than previously understood. (And not just in low- and middle-income countries, where 97 percent of RSV deaths occur, but in higher-income ones too, where the virus still fills pediatric hospital wards each winter.) That prompted us to expand our investments in RSV prevention, which led to the approval of the first maternal vaccines for RSV in 2023.

But understanding what causes childhood mortality wasn’t enough on its own, because deaths aren’t distributed evenly across countries—or even within them. That’s why our second challenge was to figure out where exactly children were dying.

At the time, most health data was collected at national or regional levels. That masked major differences in disease burden from one community to the next—and made it harder to target interventions effectively.

To solve this second challenge, the foundation invested in new approaches to health mapping that combined satellite imagery, GIS technology, GPS data, and local health surveys. These maps gave Ministries of Health and implementing partners unprecedented, anonymized detail about disease patterns and population distribution, down to individual neighborhoods, that transformed how and where public health resources are deployed—while still preserving the privacy of the individual children and families in these places.

In Pakistan—one of just two countries where wild polio remains endemic—advanced mapping tools have helped vaccination teams reach and protect kids in settlements that weren’t on any official maps. Across sub-Saharan Africa, better geographic data has transformed the fight against malaria by revealing that transmission often clusters in small, hyper-local pockets. Through the Malaria Atlas Project, countries like Nigeria can now track those patterns more precisely—and then get bed nets, testing, and treatment where they’ll have the greatest impact.

With better knowledge of what was killing children, and where, one more fundamental question remained: Why might one child die from a disease while another—who lives in the same place, faces the same risks, and gets the same treatment—survives? This was our third big challenge.

In theory, traditional autopsies would provide the answer. But in the places where most childhood deaths still occur, these invasive procedures are often impossible to perform—too costly, and sometimes opposed for religious, cultural, or personal reasons.

So in 2015, the foundation launched the Child Health and Mortality Prevention Surveillance network, or CHAMPS, which now operates in nine countries across Africa and South Asia. Working with in-country partners, CHAMPS pioneered a new autopsy alternative—using minimally invasive tissue sampling—that can determine causes of death quickly and accurately while respecting local customs and beliefs.

Through CHAMPS, we discovered that childhood deaths rarely have a single cause. Instead, kids often have multiple conditions at the same time, with malnutrition frequently leaving them much more vulnerable to a whole host of infections. (While it rarely shows up on death certificates, it’s an underlying cause of death in nearly half of all child mortality cases.) That finding helped solidify nutrition as a core focus of the foundation’s global health work—and the research, innovation, and product development we invest in. On the ground, we’re supporting partners as they integrate nutrition screening into routine care and train healthcare workers to manage multiple risks at once.

CHAMPS also demonstrated that inadequate prenatal care is responsible for a majority of stillbirths, newborn deaths, and maternal deaths, prompting us to further expand access to maternal health services—like prenatal vitamins and AI-enabled ultrasounds—in the communities where we work.

But the biggest takeaway from CHAMPS is also the most hopeful—and a reminder of why we started the Gates Foundation in the first place: So many childhood deaths could be prevented with existing interventions. We just need to ensure they reach the right children at the right time.

Twenty-five years in, our work on child mortality is far from complete. Still, the impact of what we have learned has been enormous

The Global Burden of Disease, GEMS, and PERCH studies helped shift global priorities by showing the world what was really killing kids—and where new vaccines and treatments could make the biggest difference. Better geospatial tools have empowered countries to pinpoint disease hotspots, find previously unmapped settlements, and distribute life-saving resources where they’re needed most. And CHAMPS is giving governments better data on why children are dying—data that’s now shaping policies, improving reporting, and guiding more effective care.

Most importantly, even as the number of children born every year has gone up, the number of overall childhood deaths has fallen by more than half—from 11.3 million in 1990 to 4.5 million in 2022. Playing a part in making that happen is the best job I’ve ever had, and the most meaningful work I’ve ever done.

At the Gates Foundation, we used to say we could cut child mortality in half again by 2040. The truth, though, is that goal feels further out of reach now—not because the science has stalled, but because support for global health has. The progress we’ve been part of was only possible because governments around the world, including here in the U.S., made long-term commitments to saving lives and followed through. That kind of leadership gave millions of children who would have died a chance at life—and made life better for millions more. 

The last 25 years have shown us what’s possible. The next 25 will depend on whether the world keeps showing up for the children who need it most.

In a rural health clinic, a baby tries to take her first breath.

But her lungs aren’t ready. Because she was born too early, they haven’t developed the slick, soap-like substance that keeps her air sacs from collapsing. Without that substance—called lung surfactant—breathing becomes a desperate, exhausting act.

She’s suffering from respiratory distress syndrome, or RDS, a life-threatening condition that appears within hours of birth in premature babies. Unless she gets treatment, her oxygen levels will plummet and her organs will begin to shut down. In one study from India, every baby born with RDS outside of a hospital setting died. In Ethiopia and Nigeria, RDS is responsible for almost half of all neonatal deaths.

At hospitals in higher-income countries, there’s a way to save her: a liquid form of organically-derived surfactant delivered directly into the lungs. But the procedure requires a highly-trained specialist to guide a breathing tube down the newborn’s windpipe—avoiding the stomach and placing it just right—at a cost of up to $20,000. In many parts of the world, that kind of care simply doesn’t exist.

But what if any healthcare worker anywhere in the world could simply hold a small nebulizer to the baby's face and deliver surfactant as an easy-to-administer inhalant?

This breakthrough—a synthetic surfactant that’s stable enough to be delivered through a nebulizer—is still in development, drive in part by Gates Foundation-supported research at Virginia Commonwealth University, Seattle Children’s Research Institute, and The Lundquist Institute. But its promise is extraordinary: an RDS treatment that costs less to make, doesn’t require a specialist to administer, and eliminates the need for intubation.

In other words, a therapy currently limited to the most advanced hospitals could become accessible in rural clinics and community settings around the world. Even in places with top-tier care, it could make treatment gentler, faster, and easier to deliver. In the United States—where RDS still affects 24,000 newborns a year—it could reduce the risks that come with intubating babies who might weigh only two or three pounds.

It’s the kind of innovation that could help solve one of the most persistent problems in global health: delivering intensive care without an intensive care unit, and helping millions more babies survive their first, most fragile moments.

Since 1990, the mortality rate for children under five has been cut by more than half—an amazing mark of global progress. But another statistic hasn’t fallen as fast: the number of babies who die in their first month of life.

Each year, 2.3 million newborns don’t survive past their first 28 days. And the day a baby is born is the most dangerous day of their life. The single biggest cause of these deaths is prematurity. Nearly 900,000 babies a year die from complications related to being born too soon, including infection, underdeveloped organs, and RDS.

Lower cost, easier-to-deliver surfactant is one way to give newborns a fighting chance, but it’s not the only way. Around the world, simple, affordable interventions already exist to identify at-risk pregnancies earlier, prevent more preterm births, and ensure a healthy birthing experience for mothers. Not only are these tools designed to work in the hardest-to-reach places—many of them start working even before a baby takes that first breath.

One of these innovations is a new type of ultrasound that’s changing who can catch the risks of preterm birth—and where.

Around the world, two thirds of women never get an ultrasound screening during pregnancy. Traditional machines are bulky and expensive, with specialized training required to operate them and interpret their results. In places where medical resources are already stretched thin, these types of ultrasounds are rarely an option.

But now, we have ultrasound devices about the size of a phone that can be operated by a nurse or midwife—no on-site specialist required. They weigh less than a pound. They process scans instantly. Their AI interface automatically detects high-risk conditions, like a shortened cervix or signs of early labor, so patients are referred for further care. And they have built-in telehealth functions to share images with remote specialists when needed.

By finding and flagging risks early, these AI-enabled ultrasounds are giving healthcare workers more time to act. In some cases, that means transferring the mother to a higher-level facility. In others, it means providing her with antenatal steroids—an inexpensive, underused treatment that speeds up fetal lung development—and, when needed, medications that delay labor just long enough for those steroids to take effect.

Early warning is essential, but we can save even more lives by going further upstream, starting with the health of pregnant women themselves.

In many low-income countries, undernutrition isn’t an exception. It’s the norm. And the intense demands of pregnancy make nutritional deficiencies even worse—putting mothers at increased risk of complications or death in childbirth, and raising the odds of early labor, low birth weight, and developmental delays for their babies.

But there’s a surprisingly simple fix: a daily supplement called MMS, or multiple-micronutrient supplementation, developed by the United Nations. It contains 15 essential vitamins and minerals for pregnancy—like zinc to reduce the risk of early labor, folic acid to help prevent birth defects, iron and vitamin D for healthy birth weight, and iodine for brain development. For an entire pregnancy, it costs just $2.60.

If MMS became the standard prenatal supplement in every low- and middle-income country, it could save nearly half a million newborn lives each year—and prevent serious complications in 25 million births by 2040.

The innovations above focus on treating, detecting, and preventing premature birth, a huge threat to newborn survival. But one of the most powerful ways to protect babies, preterm or full-term, is by ensuring their mothers stay healthy through pregnancy and childbirth.

When a woman dies during delivery, her baby is 46 times more likely to die in that first month of life. That’s why any serious effort to tackle infant mortality must also address postpartum hemorrhage—which tragically kills 70,000 women a year and is the leading cause of maternal mortality. Fortunately, two innovations are already helping healthcare workers catch and treat it before it becomes fatal.

The first is a calibrated drape—a simple plastic sheet placed under a woman during delivery that collects blood and shows, through printed measurement lines, exactly how much she’s losing. It gives healthcare workers a fast, accurate way to spot dangerous bleeding before it becomes life-threatening. The second is a one-time, 15-minute iron infusion during pregnancy that treats severe anemia—so if a woman does hemorrhage during childbirth, she’s less likely to experience catastrophic blood loss and more likely to survive.

Neither of these tools is complicated or expensive. But in combination, they can make a life-or-death difference for mothers and the babies who depend on them.

Taken together, these innovations form a chain of survival. They help mothers stay healthy through pregnancy. They detect problems before they become emergencies. They give fragile newborns a fighting chance. And they make it possible for families to celebrate a baby’s birth rather than mourning a loss.

Some of these tools are already saving lives. Others are on the verge of doing so. But their impact will be limited unless we prioritize and fund their delivery, not just their development. The world needs to make sure these innovations don’t get stuck in labs or warehouses—so they can reach the mothers and babies who need them most.

I’ve been giving speeches about vaccines for 25 years. After so much time, it could have become routine for me. But it never has.

One reason is that the impact of vaccines—a single dose can protect a child from deadly diseases forever—is like a miracle to me, and who gets tired of talking about miracles?

The other reason is tied to this particular moment. There’s never been a point in the past 25 years when more lives hung in the balance. In all likelihood, 2025 will be the first year since the turn of the century when the number of children dying will go up instead of down. 

Why? Governments are cutting health aid—including funds for Gavi, the vaccine organization that the Gates Foundation helped start. As a result, Gavi will likely not have all the money it needs to fund its next five years of work. 

So when I spoke this week at a summit in Brussels where donors committed a new round of funding for Gavi, I focused on why it’s so important to keep the money flowing and maintain our momentum on vaccines. You can read my remarks below.

Remarks as delivered
June 25, 2025
Global Summit: Health & Prosperity through Immunisation
Brussels, Belgium

Good evening, and thank you to everyone joining us here tonight—and for all your support for one of the most transformative efforts in the world.

I want to particularly thank President von der Leyen and President Costa, and the European Union, for co-hosting this summit. President von der Leyen has long been an incredible champion for health and development, and the EU has been one of the Gavi's biggest supporters since the very beginning—support that's more crucial now than ever.

This chart is one that I think about a lot. It's really my most favorite chart. And I consider it almost kind of a report card for humanity. Because over the last 25 years, the reduction of under-five deaths has been far faster than any time in history. We've gone from over 9 million to now half as many deaths taking place by children. This is an unbelievable result.

And it doesn't fully state the benefit of these vaccines. The vaccines leave a lot of kids far more healthy, and so their ability to achieve their potential is increased.

Gavi prioritizes saving lives, and it's done with incredible scientific rigor. We're constantly improving vaccines. We're constantly looking at the safety, and I'm very proud of the work that's done to make sure that these vaccines are incredibly safe.

The founding of Gavi actually goes back to about the time the Gates Foundation was first started. And after 25 years, I can still say that it's at the top of the list of things that I'm very, very proud of. At that time, kids were not getting access to vaccines. They were too expensive. They hadn't been formulated properly. And I was stunned to learn that so many kids were dying from a disease like rotavirus because the vaccine wasn't getting out to all the children of the world.

So Gavi was created to not only help finance vaccines, but work with countries to adopt these new vaccines.

We've done an amazing job of getting these prices down. A good example is the pneumococcal vaccine, PCV. This vaccine became available in high-income countries the year that Gavi was founded. And it does a fantastic job of protecting kids against pneumonia, which was the single most deadly childhood infection. But it was very expensive.

And so Gavi and its partners incentivized vaccine manufacturers to develop a new, much cheaper PCV, which was introduced in 2017. Today, the manufacturers make PCV vaccines available to low-and middle-income countries for just $2 a dose.

And of course, we've seen similar reductions across all of the different vaccines, allowing us to add new vaccines to save even more children.

Since the founding of Gavi, the overall cost of fully vaccinating a child has been cut in more than half.

And we have a pipeline of new vaccines coming along, vaccines to address new diseases and that bring down costs even further.

A good example of this is the HPV vaccine. Cervical cancer, which HPV prevents, is the fourth most common cancer in women around the world. And this vaccine can prevent over 90% of these cases.

But countries were slow to adopt this vaccine, in part because it was hard to deliver: initially, it required three doses spread across six months.

Scientists believed that perhaps it could be done with fewer doses. And so the Gates Foundation funded a trial to see whether a single dose was essentially fully protective. And after seeing the incredible results, the WHO approved a single dose schedule in 2022.

Now, we have 75 countries around the world that have moved to this single dose approach.

And because the single dose is cheaper and easier to deliver, it's now getting to far more girls around the world. For example, after Nigeria introduced the single-dose vaccine, it was able to vaccinate more than 12 million girls in less than a year. That's really incredible.

Across Gavi countries, HPV vaccine coverage has increased dramatically. The year after this single-dose approval, we doubled the number of girls getting the vaccine. And [the next year] we doubled it again, and this year we'll double it again.

There's more than just making vaccines available. We have to work with our partner countries on helping improve their health systems. So the Gavi Alliance has spent a lot of its resources and a lot of its technical support in helping improve those primary health care systems, which are so vital. We've helped countries understand where they're missing kids and how to invest in raising those coverage levels.

As you've heard, over this 25-year period, that means over a billion children have been vaccinated—resulting in the saving of over 19 million lives.

Nineteen million is a big number. It's almost easier to understand if I just say: okay, here's a child whose life was saved. But you have to take your reaction to how valuable that is and multiply it by this absolutely gigantic number.

The total cost to save those lives was about $22 billion. And that means that Gavi saved children's lives for only about $1,000 per life saved.

And in addition, the kids who these vaccines have kept healthy not only go to school; they do well in school. They join the economy. They contribute to their country. And really, this is why improving health through vaccines is part of the formula for helping countries be self-sufficient.

Gavi's vaccination has generated $250 billion in economic benefits in the countries it supports. In fact, Gavi has had such an extraordinary economic benefit that over 19 countries that were Gavi recipients have now graduated, meaning they now fully fund their own immunization programs.

A great example is Indonesia. Since partnering with Gavi, it’s doubled the number of vaccines offered through its routine immunization program—and it’s seen childhood deaths fall to a quarter of what they were before. And now, Indonesia is not only transitioning to be fully self-supportive—it’s also become a Gavi donor.

Of course, this is a challenging time. All the progress we’ve made is at risk. Budgets are tight, and we all have to show our priorities when there’s tough trade-offs to be made.

There’s no denying: this is a global health crisis. Between the U.S. cuts and other funding cuts, in total, aid in total has gone down by 30 billion this year alone. It reinforces the incredible values being shown by the people who are showing up here today and being incredibly generous.

But with the cut in health resources, along with the financial situation a lot of these low-income countries are in, we are going to have a few years where things will go backwards.

As we think about this, think of a mother who will bring a baby wheezing for breath to a help center, and because the vaccines aren't available, that baby will not survive.

Think of a health worker trying to deal with a measles outbreak who, because there's less resources for that primary health care system or vaccines, that measles epidemic will continue.

This is agonizing. I mean, we have to put ourselves in the position of the parents who lose these children and how tough it must be for them to realize that the life could have been saved by a vaccine that costs just 30 cents.

So though our trend lines will briefly go into reverse, I believe that we can come back. I believe that we will resume that incredible progress that you saw.

I don't know if it'll be in two years or four years or six years, but I do know that as we bring these resources back, and we take advantage of an incredible pipeline of innovation, new drugs, new vaccines—lots of amazing things to help with these diseases—we will resume progress.

So everyone here, I'd say, is recommitting themselves, just like the Gates Foundation, to doubling down and staying committed.

You know, I'm not pessimistic. In fact, we have things like polio eradication that we are, as we say, this close to elimination. That'll be a mind-blowing thing. Likewise, malaria: we have tools, a variety of tools that brought together will give us a chance in the next 20 years to completely eradicate that as a disease, just like we're doing with polio.

This is all why the Gates Foundation is pledging $1. 6 billion to Gavi for this next five-year period. Thank you.

And it's why we'll invest billions in making sure that pipeline of new and lower-cost vaccines continues to make Gavi even more effective.

In closing, I think we can reflect on what Nelson Mandela once said: “There can be no keener revelation of a society's soul than the way it treats its children.”

In the last 25 years, Gavi has helped over a billion children live better, healthier lives—thanks to the extraordinary support of partners like you.

If we get this right, this trajectory of progress will continue for decades to come.

Thank you.

I’ve been working in global health for 25 years—that’s as long as I was the CEO of Microsoft. At this point, I know as much about improving health in poor countries as I do about software. 

I’ve spent a quarter-century building teams of experts at the Gates Foundation and visiting low-income countries to see the work. I’ve funded studies about the effectiveness of health aid and pored over the results. I’ve met people who were on the brink of dying of AIDS until American-funded medicines brought them back. And I’ve met heroic health workers and government leaders who made the best possible use of this aid: They saved lives. 

The more I’ve learned, the more committed I’ve become. I believe so strongly in the value of global health that I’m dedicating the rest of my life to it, as well as most of the $200 billion the foundation will give away over the next 20 years.  

People in global health argue about a lot of things, but here’s one thing everyone agrees on: Health aid saves lives. It has helped cut the number of children who die each year by more than half since 2000. The number used to be more than 9 million a year; now it’s fewer than 5 million. That’s incontrovertible.  

So when the United States and other governments suddenly cut their aid budgets the way they've been doing, I know for a fact that more children will die. We’re already seeing the tragic impact of reductions in aid, and we know the number of deaths will continue to rise.

A study in the Lancet looked at the cumulative impact of reductions in American aid. It found that, by 2040, 8 million more children will die before their fifth birthday. To give some context for 8 million: That's how many children live in California, Texas, Florida, New York, Pennsylvania, and Ohio combined. 

I’ve submitted written testimony on this topic, which you can read below, for the Senate Appropriations Committee hearing occurring later today. In it, I discuss what’s already happened and what needs to happen next.

Testimony to the United States Senate Committee on Appropriations
June 25, 2025

Over the past 25 years—the same span of time I spent leading Microsoft—I have immersed myself in global health: building knowledge, deepening expertise, and working to save lives from deadly diseases and preventable causes. During that time, I have built teams of world-class scientists and public health experts at the Gates Foundation, studied health systems across continents, and worked in close partnership with national and local leaders to strengthen the delivery of lifesaving care. I have visited hundreds of clinics, listened to frontline health workers, and spoken with people who rely on these programs. Earlier this month, I traveled to Ethiopia and Nigeria, where I witnessed firsthand the impact that recent disruptions to U.S. global health funding are having on lives and communities.

Global health aid saves lives. And when that aid is withdrawn—abruptly and without a plan—lives are lost.

Yet, in recent months, some have questioned whether the foreign assistance pause has caused harm. Concerns about the human impact of these disruptions have been dismissed as overstated. Some people have even claimed that no one is dying as a result.

I wish that were true. But it is not.

It is important to note that while this hearing is about the Trump Administration’s $9 billion recission package, what is really at stake is tens of billions of dollars in critical aid and health research that has been frozen by DOGE with complete disregard for the Congress and its Constitutional power of the purse.

In the early weeks of implementing the foreign aid freeze, DOGE directives resulted in the dismissal of nearly all United States Agency for International Development (USAID) staff and many personnel at the Centers for Disease Control and Prevention (CDC). Some funding was later restored to allow for the continuation of what has been categorized as "lifesaving" programs. However, to date that designation has been applied narrowly and with limited transparency, in an inconsistent manner, often prioritizing emergency interventions when a patient is already in critical condition over essential preventative or supportive care.

For example, providing a child with a preventive antimalarial treatment, ensuring access to nutrition so that HIV/AIDS medications can be properly administered, testing pregnant women for HIV to see if they are eligible for treatment to prevent transmission to their children or identifying and treating tuberculosis cases early have not consistently qualified for exemption. As a result, many of the programs delivering these services have been suspended, delayed, or scaled back.

Recent reporting from the New York Times has shed light on the devastating human cost of the abrupt aid cuts. One especially tragic example is Peter Donde, a 10-year-old orphan in South Sudan, born with HIV, who died in February after losing his access to life-saving medication when USAID operations were suspended. His story is one of many.

During my recent visit to Nigeria, I met with leaders from local nonprofit organizations previously funded by the United States. One group shared the remarkable progress they had made in tuberculosis detection and treatment. In just a few years, case identification increased from 25 percent to 80 percent, a critical step toward breaking transmission and reducing the overall disease burden. That progress has now stalled. The grants that enabled this work were tied to USAID staff who have been dismissed, and with their departure, the funding ended, and the work stopped.

The broader effects of these sudden shifts are difficult to overstate. For example, funding for polio eradication has been preserved in the State Department budget but cut from the CDC—even though the two agencies collaborate closely on the program. This type of fragmented decision-making has left implementing organizations uncertain about staffing and operations. Many no longer feel confident that promised U.S. funds will materialize, even when awards have been announced. In some cases, staff continue to work without pay. Some organizations are approaching insolvency.

Meanwhile, in warehouses across the globe, food aid and medical supplies sourced from American producers are sitting idle—spoiling or approaching expiration—because the systems that once distributed them have been disrupted. Clinics are closing. Health workers are being laid off. HIV/AIDS patients are missing critical doses of medication. Malaria prevention campaigns, including bed net distributions and indoor spraying, have been delayed or canceled, leaving hundreds of millions of people unprotected at the peak of transmission season.

Efforts to track data that would illustrate the severity of this worsening crisis have also been severely compromised. Many of the people responsible for collecting and reporting health information—health workers, statisticians, and program managers—have been laid off or placed on leave. The systems that once monitored health outcomes are shutting down, and the offices where that data was once analyzed now sit empty. As a result, the true scope of the harm is becoming harder to measure, just as the need for information is most urgent.

The situation we face is not about political ideology, and it is not a debate over fiscal responsibility. U.S. government spending on global health accounts for just 0.2 percent of the federal budget. Shutting down USAID did nothing to reduce the deficit. In fact, the deficit has grown in the months since.

Furthermore, many of the allegations regarding waste, fraud, and abuse have proven to be unsubstantiated. For example, the widely circulated claim that USAID sent millions of dollars’ worth of condoms to the Gaza Strip is inaccurate. In fact, the Wall Street Journal reported that the program allocated approximately $27,000 for condoms as part of an HIV transmission prevention initiative—not in the Middle East, but in Gaza Province, Mozambique.

What we are witnessing because of the rapid dismantling of America’s global health infrastructure is a preventable, human-caused humanitarian crisis—one that is growing more severe by the day. DOGE made a deadly mistake by cutting health aid and laying off so many people. But it is not too late to undo some of the damage.

A Record of Progress—and What is at Risk

Since 2000, child mortality worldwide has been cut in half. Deaths from HIV/AIDS, tuberculosis, and malaria have declined significantly. And we are on the verge of eradicating only the second human disease in history: polio. These are not abstract statistics; they represent tens of millions of lives saved. None of this progress would have been possible without consistent, bipartisan U.S. leadership and investment.

Over the past several decades, the United States has built one of its most strategic global assets: a respected and robust public health presence. This leadership is not just a humanitarian achievement—it is a core pillar of American soft power and security. For example, a Stanford study analyzing 258 global surveys across 45 countries found that U.S. health aid is strongly linked to improved public opinion of the United States. In countries and years where U.S. health aid was highest, the probability of people having a very favorable view of the United States was 19 percentage points higher. Other forms of aid—like military or governance—did not have the same effect. Another example is the 2014 Ebola outbreak in West Africa. The rapid deployment of U.S. scientists, health workers, and CDC teams helped contain the virus before it could spread globally. Their presence allowed the U.S. to help shape the response strategy, speed up containment, and prevent a wider outbreak. Many African countries are facing the dual burden of rising debt and pressing health needs, forcing painful choices between repaying creditors, and protecting their citizens. Helping them navigate this challenge is not just the right thing to do—it is a strategic imperative. If the United States retreats, others will fill the gap, and not all of them will bring our values, our priorities, or our interests to the table. Preserving American global influence will require restoring the staff, systems, and resources that underpin it—before the damage becomes irreversible.

I understand the fiscal pressures facing Congress. I recognize the need to prioritize spending and to hold programs accountable for results. I also share the Trump Administration’s commitment to promoting efficiency and encouraging country-led solutions. But I believe those goals can—and must—be pursued while still protecting the programs that deliver the highest return on investment and the greatest impact on human lives.

The United States’ support for Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the President’s Emergency Plan for AIDS Relief (PEPFAR); and the Global Polio Eradication Initiative (GPEI) represent some of the smartest, most effective investments our country has ever made. These initiatives are proven, strategically aligned with American interests, and cost-effective on a scale few other government programs can match.

Together, Gavi and the Global Fund have helped save more than 82 million lives. Gavi has helped halve childhood deaths in the world’s poorest countries and returns an estimated $54 for every $1 invested. The Global Fund has contributed to a 61% reduction in deaths from HIV/AIDS, TB, and malaria. PEPFAR has saved over 26 million lives and helped millions of children be born HIV-free. GPEI has brought us closer than ever to the eradication of polio. Pulling back now would not only jeopardize these historic gains—it would invite a resurgence of preventable disease, deepen global instability, and undermine decades of bipartisan American leadership.

This is not a forever funding stream for the U.S. Government. These programs set out clear pathways for countries to “graduate” from aid, which many have already done. For example, nineteen countries, including Viet Nam and Indonesia, have successfully graduated from Gavi support and now fully finance their own immunization programs. Others—from Bangladesh to Cote d'Ivoire—are on track to do the same. This is how U.S. development policy should work: catalytic, cost effective, and designed to help countries become self-reliant and drive their own progress. I agree that aid funding should have an end date, but not overnight. The most effective path to that end date is innovation. By investing in the development and delivery of new medical tools and treatments, we can drive down the cost of care, and in some cases, make diseases that were once a death sentence treatable, or even curable. Advances in therapies for chronic conditions like sickle cell disease, HIV, or certain types of cancers could transform lives and health systems. American innovation offers a sustainable exit strategy—one that reduces long-term costs, allows the United States to responsibly step back, and builds lasting trust and good will that far exceed the original investment.

Over the past 25 years, the Gates Foundation has invested nearly $16 billion in global health partnerships like Gavi, the Global Fund, and GPEI. We will continue to invest, through innovation, research, and close coordination with partners. But no private institution—or coalition of them—can replace the scale, reach, or authority of the U.S. government in delivering lifesaving impact at the global level.

The decisions made in the coming weeks will shape not only the lives saved in the near term—but the legacy of American leadership for generations to come.

Download a PDF of the testimony with appendices that include reflections from Gates Foundation staff in Africa on the impact of the U.S. aid cuts; analytical projections from respected organizations; and a selection of first-hand reporting from reputable news organizations and journalists.

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 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.

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.

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.

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.