On September 25, 2015, at the United Nations headquarters in New York, 193 world leaders committed to achieving the 17 SDGs (Global Goals), a series of ambitious objectives and targets to end poverty, fight inequality, injustice, and as well fix climate change, amongst others, by 2030. And from 2000 to 2015, these goals were aggressively worked on until the COVID-19 pandemic hurled whatever achievements recorded downwards as shown in the annual Goalkeepers Report for 2022, which stated that on the 18 indicators – from poverty to gender equality, education to food security, health to climate – the world was off track.But it’s still not all gloom, philanthropist and co-chair of the Bill and Melinda Gates Foundation, BMGF, Bill Gates, says to Chiemelie Ezeobi, during a one-on-one interaction on the sidelines of the 2023 Goalkeepers’ event in New York. Excerpts:
Every year, countries make promises to achieve global goals, but they often fail to meet these targets. What’s the solution? How can we shift from just talking to taking meaningful action?
From 2000 to 2015, known as the Millennium Development Goals era, we actually surpassed those goals. The world came together, addressing various health challenges. We tackled issues like child vaccinations through initiatives like COVID-19 vaccine programmes for children and the Global Fund’s efforts against malaria, tuberculosis, and HIV. During this time, child survival improved significantly. However, Nigeria faced ongoing challenges in its primary healthcare system, including facility limitations, staffing shortages, and supply issues.
Despite these hurdles, there was remarkable progress. The number of child deaths decreased from 10 million to 5 million by 2015. In 2015, our foundation collaborated with the UN and set ambitious goals to continue this progress. Although the pandemic, the Ukrainian war, financial instability, and market fluctuations posed challenges, our dedication to these goals remained unwavering. Every life matters, and even if we fall short of our ambitious targets, reducing deaths remains crucial.
We focus on improving primary healthcare centers’ quality and ensuring staff availability. In this pursuit, we’ve developed seven low-cost interventions, some of which are new, while others have been pioneered in Nigeria. I had the opportunity to witness a doctor conducting a trial, and one particularly exciting intervention is the intravenous iron infusion. This innovative approach swiftly reduces anemia, benefiting both mothers and children significantly.
Among the 17 Sustainable Development Goals (SDGs), which one do you believe is making good progress, and which one do you think receives insufficient attention from world leaders?
Our expertise lies in health, and I may be biased, but I believe that health is fundamental. When a child suffers from malnutrition, not only does their risk of death increase fourfold, but their potential is also severely compromised. Malnourished children struggle to receive an education and contribute to their families and their nation’s development.
In the realm of health, we have access to very cost-effective interventions, such as the measles vaccine, which costs just a few dollars. Comparatively, the journey to finding a cure for diseases like cancer is ongoing, and we will get there eventually. However, when it comes to building and developing a country, the immense impact of providing affordable vaccines to all children cannot be overstated.
I recall when Dr. Pate (the current minister of health in Nigeria) was in the government, he initiated a health drive aimed at saving a million lives. Given the high child mortality rates in the northern region of Nigeria, our country has a unique opportunity to make a substantial difference. By ensuring the basics are in place, including finances, staffing, and supplies, and then integrating these new, cost-effective innovations, the impact can be nothing short of dramatic.
In your recent panel discussion with President William Ruto of Kenya, he raised the issue of debt relief for indebted countries, emphasising that addressing debt is essential for progressing towards global goals. What specific steps do you believe should be taken to chart a way forward in this regard?
President Ruto, speaking on behalf of African presidents, and I’m confident President Tinubu would echo similar sentiments, has observed a decline in the amount of debt relief and aid reaching Africa, particularly since the onset of the pandemic and due to factors like the Ukraine war and the refugee crisis. In some instances, there seems to be a growing tendency to take development for granted, with a shift towards prioritising climate initiatives over fundamental development issues like prenatal care visits and essential healthcare practices that yield significant impacts.
It’s challenging to predict the exact amount African countries will receive, as many nations are turning inward, and there’s a growing sentiment of prioritising domestic interests, often referred to as “America First” and similar notions. While it would be reassuring to secure assistance for these debt-related issues, our foundation remains the largest global advocate for encouraging developed countries to increase their generosity towards developing nations, with Africa being a major focus of these efforts.
In your recent global report, you highlighted that 800 women lose their lives every day due to childbirth-related issues, and you proposed various interventions. How do you ensure that these interventions are customised to suit the unique circumstances of less developed countries, which may lack the same infrastructure as more advanced nations? Can you explain your approach to tailoring these interventions to meet the specific needs of each country?
Each of these interventions was developed in developing countries, like the IDR trial, which had contributions from multiple parts of Nigeria. Even within Nigeria, it’s essential to consider regional differences, as the delivery challenges may vary significantly. We’ve extended these trials to places like Kenya to assess their practicality in different contexts. For instance, the aspect of conducting intravenous iron infusions, we’re examining whether healthcare facilities in the northern regions have the capacity to do it safely. It’s an ongoing learning process.
Additionally, we’re exploring how to utilise cell phones equipped with sensors to simplify the training process and guide practitioners on where to make the insertion, reducing the skill required compared to current methods. The foundation’s focus remains on addressing the most fundamental factors that can save lives, and many of our staff members have firsthand experience working in these challenging conditions.
Maternal mortality, particularly in Africa and Nigeria, is exacerbated by reported cases of abuse during childbirth by midwives and healthcare workers. Aside from providing funding, does your foundation also offer training to maternal healthcare workers to ensure safe and respectful childbirth practices?
While our philanthropic organisation in Nigeria contributes significantly, we aren’t responsible for funding staff salaries. We collaborate closely with the government on this matter. The payment of salaries is typically managed by the government itself or through borrowing from other partners like the World Bank or the Development Bank. We are deeply involved in training programmes to equip individuals with the necessary skills and knowledge. However, the impact only truly counts when these trained personnel can effectively apply their expertise in the field.
We are committed to simplifying processes, such as vaccine distribution, to make them more efficient than before. To achieve this, we conduct patient surveys to gather feedback on their experiences. We inquire about why they sought healthcare, whether they were influenced by rumours, their knowledge of health centers, and the overall effectiveness of their visits.
In some extreme cases, like when negative rumors about vaccines threatened the polio eradication campaign at the turn of the century, we engaged with traditional leaders to build campaigns. These campaigns allowed people to hear from trusted sources, who were vaccinating their own children. This ongoing relationship with community leaders serves as a vital channel for disseminating essential information to families.
Collaboration is crucial, and no single organisation or country can address global issues alone. How do you strengthen your commitment to tackling these global challenges through the alliances you have established?
Early in our existence, we established the Global Alliance for Vaccines, and we contribute approximately 18 per cent of the funding. The rest of the funding comes from wealthy governments like the USA, UK, and Germany. We’ve also established global funds, where our foundation and governments collaborate on funding. In each area we operate, we form partnerships. In Nigeria, for instance, the Aliko Dangote Foundation is a vital partner. Aliko Dangote not only brings commitment but also a deep understanding of the medical issues. Our foundation’s expertise in healthcare, combined with his generosity and local insights, strengthens our efforts.
Nevertheless, we are continually seeking additional partners. Organisations like the World Health Organization (WHO) and UNICEF, with their distinct capacities, are instrumental in our mission. We are particularly pleased that Dr. Pate, whom we are well-acquainted with and who possesses profound knowledge of Nigeria’s health challenges, has been appointed by the president to take on the task of improving healthcare.
Your motivation raises some curiosity. Many wealthy individuals don’t engage in philanthropy to the extent you do. What drives you to want to leave such a significant philanthropic legacy?
When I was fortunate enough to achieve incredible success with Microsoft, it generated an astonishing amount of wealth, exceeding a billion dollars. My central question was, how I could make the most impactful contribution back to society. That led us to conduct a study on child mortality in developing countries. We discovered that very little funding was allocated to critical issues like malaria, pneumonia, and diarrhea. While vaccines were readily available for affluent children, those at serious risk in nearly all of Africa were being left without this essential protection. This inequality troubled me deeply, and it became evident that both Melinda and I needed to make global health the primary focus of our philanthropic efforts.
We embarked on this mission by assembling a team of experts, including specialists in malaria, HIV, and maternal and child health. Today, you can see Dr. Obi on stage with me, who is an expert in maternal and child health. Together, we form a strong and knowledgeable team, leading the way in this field. Our work in global health is a full-time commitment. I visited Nigeria in June, and in October, I’ll be in Senegal for our Grand Challenges event. Although we are facing some challenges, especially in terms of funding for Africa, we remain dedicated to the cause. Every year, we strive to reduce the number of child deaths in Africa, and I take great pride in supporting exceptional individuals doing this vital work.
Talking about the Goalkeepers, how do you source for talents and how do you ensure sustainability of each projects they carry out in their respective countries?
We don’t shoulder the entire responsibility ourselves. Instead, we aim to assist individuals and organisations dedicated to noble causes. We provide them with opportunities to learn from one another and develop local support networks. The world’s needs are vast and surpass our capacity to address them all comprehensively.
In the realm of healthcare, our primary focus is on reducing health inequities. This remains at the core of our mission. However, we also extend our support to those working on various other important issues.