2021 gates annual letter: in this year, global health will share weal and woe with you and me

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Source: Gates Foundation
When we write this letter, we have just experienced an unprecedented year.
Twenty years ago, we founded the Gates Foundation, which focuses on global health and hopes to use the revenue from Microsoft to improve the lives of as many people as possible. Health is the cornerstone of the prosperity and development of any society. If your health is under threat and you are always worried about something that might be fatal, it’s hard to devote yourself to anything else, because survival and health will be your top priority.
For the first time in the past year, many people have experienced this personally. Now, before novel coronavirus pneumonia is taken, we should consider a new factor: how can we minimize the risk of infection or spread of new crown pneumonia?
This letter may be read by some epidemiologists, but for most people, we suspect that they have been forced to learn a whole new set of vocabulary in the past year and try to adjust to such life, such as “social distance”, “flattening curve” and “R0 value” of some virus, etc. (for the epidemiologists who are reading this letter, you may never believe that your colleague Anthony fudge is on the cover of the fashion magazine InStyle.)
When the last year’s letter was written last year, the world was just beginning to understand the possible impact of the New Coronavirus pandemic. Novel coronavirus pneumonia has been a major concern for the world’s outbreak of pandemic diseases, especially after the Ebola outbreak in West Africa, but the impact of the new crown pneumonia epidemic on the economy, employment, education and social life around the world is still unanticipated.
After hearing the novel coronavirus pneumonia (COVID-19) for only a few weeks, we closed the foundation’s offices in various places and began adapting to different lifestyles with billions of people around the world. For us, the day has become a chaotic time of video conferencing, worrying news push and microwave fast food.
But compared with the impact of the epidemic on other people, the compromise we made was negligible. The novel coronavirus pneumonia has killed people’s lives, millions of people have been afflicted by the disease, and the global economy has been in serious recession. One and a half billion children have been forced to suspend classes, and some of them will never be able to return to class. The staff who stick to the key positions are doing the work that ordinary people can’t imagine, and they and their families are bearing huge risks. Stress and isolation also have a profound impact on mental health.
Many families in every country regret to miss many of the most important moments in their lives – graduations, weddings, and even funerals. (our father, old Bill Gates, passed away in September last year, but we can’t get together to mourn him and make this parting more sad.)
■ there may be differences within countries or regions in the policy of closing schools. If some areas of a country require suspension, the country is marked as “request suspension (only some levels)” / our world in data
The past few months may leave a heavy legacy in history. This is the most painful period of the whole epidemic period, but the hope is just around the corner. Although the road to recovery is still long, in this battle against the virus, the world has won a major victory in the development of new detection tools, drugs and vaccines. We believe that these tools will soon be able to significantly flatten the epidemic curve.
At this moment, we can’t help thinking of a sentence by Winston Churchill. In the autumn of 1942, Britain won a battle against Nazi Germany. Churchill thought this was the turning point of the war. In his famous speech to commemorate the victory, he warned: “this is not the end, or even the prelude to the end, but it may be the end of the prelude.”
As for the current novel coronavirus pneumonia epidemic, we believe optimistically that the “end of the preface” is just around the corner. We are also soberly aware that, in order to go to today, the world has made unprecedented efforts in public health. Policy makers, researchers, medical staff, business leaders, grassroots organizations, religious groups and many other people from all walks of life are working together in a new way.
This kind of cooperation is very important, because when we are faced with this kind of global crisis, we do not want to see the decision-making of enterprises only out of business interests, nor do we want to see governments only focus on protecting their citizens narrowly. What we need is for different groups of people and interest groups to unite and work together for the well-being of mankind.
Philanthropy can lead to such cooperation. The Gates Foundation has 20 years of working experience in infectious diseases. We have long-term and in-depth cooperation with the World Health Organization, public health experts, the government and the private sector. At the same time, because the Gates Foundation focuses on the challenges faced by the world’s poorest people, we also know that the world needs to fully consider the unique needs of low-income countries, which is particularly important.
So far, novel coronavirus pneumonia has been invested by the Gates foundation for $1 billion 750 million. Most of the money is spent on the production and purchase of important medical supplies. For example, novel coronavirus pneumonia is a new drug for researchers. We are also working with partners to ensure that these drugs are formulated to facilitate their delivery and use in the poorest regions, benefiting people around the world.
The novel coronavirus pneumonia vaccine is also supported. In the past 20 years, we have provided resources to support the research and development of 11 vaccines, and the safety and effectiveness of these vaccines have been verified. The novel coronavirus pneumonia vaccine is being developed by our partners.
Novel coronavirus pneumonia vaccine may be available to you or some people around you when you read this letter. Absolutely ignorant of the novel coronavirus pneumonia, we need to follow a very strict process to verify the safety and efficacy of a vaccine, only in early 2020. (you must understand that although the development of these vaccines has been accelerated, they still need to follow strict review before they are finally approved.)

A novel coronavirus pneumonia / Getty Images / Spencer Blatt is being taken by a sanatorium in New York.
No country or enterprise can achieve this goal independently. Donors from all over the world donate generously, competitors share research results, and global investment in technology over the years has opened a new era of vaccine development, all of which enable each participant to seize the opportunity. If the new coronavirus does not appear in 2019, but in 2009, the process of vaccine development will be much longer.
Of course, developing a safe and effective vaccine in the laboratory is just the beginning. Because the world needs billions of doses of vaccine to protect everyone from the threat of this disease, we help our partners explore how to promote the follow-up production in the process of vaccine development (generally speaking, the process is sequential).
Now, we need to start with front-line medical workers and other high-risk groups, so that everyone in the world who needs these vaccines can get them. Before novel coronavirus pneumonia was launched, the Gates foundation also worked with vaccine manufacturers and partners to deliver other vaccines at low prices (including vaccines provided to 822 million children in low-income countries through the global alliance for immunization).
Novel coronavirus pneumonia challenges are also being addressed by our foundations and partners. In 2006, our good friend Warren Buffett donated most of his wealth to the foundation, doubling our resources. He urged us to focus on the core issues that are critical to our mission. Fighting against novel coronavirus pneumonia is undoubtedly a key task in the global health undertaking in 2020, but it is by no means the only job we had last year. Our colleagues are actively promoting progress in various project areas of the foundation.
Affected by the epidemic, it is not safe to distribute mosquito nets to a large number of people through an event, so the malaria team needs to reconsider how to distribute mosquito nets. We also help partners novel coronavirus pneumonia affect pregnant women and infants, and ensure that they continue to receive the necessary medical services.
Our partners in the field of education help teachers adapt to distance learning through laptops. In other words, we are still moving towards the vision that has been established since the foundation was founded: to give everyone in the world the opportunity to live a healthy and productive life.
■ medical workers distribute mosquito nets in Benin / Getty pictures & yanick folly
■ a high school teacher in Seoul, South Korea teaches for students remotely / sung Jung
■ medical staff wearing personal protective equipment help a woman give birth in Ankara, Turkey / Getty & ozge elif kizel
If there’s any reason to be optimistic about the world after the epidemic, it’s that although the epidemic forces many people to learn new words, it also gives a new meaning to the old saying “global health”. In the past, “global health” was rarely really used to describe the health of everyone in every region of the world. In fact, people in rich countries often use this word to refer to the health status of the population in poor countries, although the more accurate word to describe this situation may be “health in developing countries”. But that changed last year. In 2020, global health and local health will be integrated. In the face of viruses that ignore national or geographical boundaries, the artificial division between rich and poor countries collapses in an instant.
We have witnessed a scene in which an unheard of disease breaks out in a place you may never have set foot on, rapidly forming a public health emergency around you. Viruses like novel coronavirus pneumonia remind us that no matter how different we are, from a biological standpoint, everyone in the world is closely linked to the microscopic network of microbes and particles. Whether you want to accept it or not, we are all in a boat. We hope that the experience we went through together last year will profoundly change people’s views on global health, and let people in rich countries see that investment in global health can benefit not only people in low-income countries, but also all people. The novel coronavirus pneumonia assistance program in the US is very excited to see a $4 billion investment to support the global alliance for vaccines and immunization. This kind of investment can make us better prepared for the next global challenge.
The novel coronavirus pneumonia, which we are experiencing, will redefine the life of our generation, just as the second world war is the decisive event of our parents. World War II urged all countries to strengthen cooperation, maintain peace and realize common interests. Now, we also have the opportunity to translate the hard won lessons learned from the crisis into a healthier and more equal future for all. In the next section, we will address two areas that are critical to building a better future: prioritizing equity issues and preparing for the next pandemic.
At the end of the epidemic,
Can we make progress on the issue of fairness?
Melinda: one of the things I miss the most in the past year is going to see the work of our foundation in the field. Photos of the women I met on these trips can be seen all over my home. Even now I work from home, I can see their faces from time to time.
I often wonder what the epidemic is like in their eyes and how they are coping with it. In video conversations with experts and leaders around the world, I also imagine how the decisions made in these conversations will affect these women and their families. They remind me that no one can be left behind in COVID-19’s global response.
From AIDS to Zika virus to Ebola, the outbreak of these diseases presents a cruel pattern. They do more harm to some people than to others, and it is often the same group of people who suffer the most. While they affect the whole society, they also aggravate the existing inequality.

The impact of novel coronavirus pneumonia is also true. People who are lack of resources are more impacted by the epidemic than those who are rich in resources; staff in key positions are more at risk than those who can work at home; students who can’t access the Internet lag behind more than students who can learn from distance. In the United States, people of color have higher morbidity and mortality rates. Around the world, women who have been fighting for the power and influence of life have seen the tiny progress made in the past few decades go to pieces in just a few months.
Novel coronavirus pneumonia has been working hard to cope with the social and economic inequalities caused by the new crown pneumonia since the outbreak of the Gates foundation, and prevented the existing inequalities from aggravating.
In the United States, many of our efforts in fighting against COVID-19 are closely related to our efforts to promote racial equality. For example, novel coronavirus pneumonia novel coronavirus pneumonia is three times more likely to be infected in the United States, and they are more likely to live in areas where there is no new crown pneumonia detection capacity. To meet the testing needs of local communities, the Gates Foundation works with traditional black colleges and universities to improve the ability of new crown diagnostic testing on campus.
■ healthcare workers testing people for new coronavirus in Nashville, Tennessee / mahari medical school
We are also addressing the unequal impact of the epidemic on people of color through other means, including the foundation’s work in the field of education in the United States. We worry that students from all grades may drop off their classes. (last year, when the classes were closed, the average student lost a few months’ learning time), but we are especially worried that COVID-19 will aggravate the longstanding barriers to higher education, especially for black, Latino and low-income students. The median lifetime income of college graduates is twice that of high school graduates, so this problem will have a profound impact on these young people.
To help students overcome the obstacles posed by COVID-19, the Gates foundation has expanded its cooperation with three organizations. They have been using digital tools to help students keep learning and earn a university degree. We believe that the models and methods that these organizations are exploring will continue to bring more opportunities to students after the epidemic.
Speaking of work outside the United States, my main task is to call on world leaders to focus on women when coping with COVID-19. The epidemic and the recession it has caused have a greater impact on women. If the government ignores this fact, the crisis will be further prolonged, and the delay of economic recovery is bound to affect everyone.
For example, because of the economic downturn last year, hundreds of millions of people in low-income countries need government help to survive. But ironically, governments often turn a blind eye to the women who are most in need. It’s very difficult to transfer money safely and quickly to women who don’t have tax payment records, formal identification, or mobile phones.
Unless these financial systems are designed specifically for women, they are likely to ignore their needs and push them further to the edge of the economy. Our foundation is also working with the world bank to help countries overcome obstacles and build digital transfer programs that truly take women’s needs into account.
■ a salesman in sirana, India helped a woman complete a bank transaction.
More broadly, we are supporting the design of economic response plans for women and low-income workers. In low – and middle-income countries, the poorest people are often self-employed in the informal sector, such as farmers or street vendors. Policy makers often ignore these people, and traditional economic stimulus measures cannot meet their needs. (tax breaks can’t help people who don’t pay taxes, but how can people who work for themselves get paid leave?) The Gates Foundation is also funding research on how the government can fix the loopholes in the social security system by giving priority to cash assistance, food relief and deferred rent and utilities.
Last year, women’s unpaid labor became the focus of people’s attention, and I also talked about this issue in my previous letters. Now, billions of people are isolated at home, and the demand for unpaid care such as cooking, cleaning and parenting is surging. Women already do three-quarters of the work. In the epidemic, the burden on their shoulders is even heavier. Although this kind of work is unpaid, it has to pay a huge price: globally, every two hours of increase in women’s unpaid nursing work will reduce women’s labor participation rate by 10%. As the government reinvigorates the economy, we should also begin to see parenting as an important infrastructure, worthy of funding like building roads and laying fiber optic cables. In the long run, this will help create a more productive and inclusive post epidemic economy.
Novel coronavirus pneumonia is the biggest worry for Bill and me. However, the epidemic will not only expose many inequalities, but also create a new problem: immune inequality, that is, only the most affluent people will be vaccinated against the new crown pneumonia, while others will not be vaccinated.
Rich countries have been buying a lot of vaccines in advance months ago to ensure that their citizens can be vaccinated immediately after they are approved. From the current situation, low-income countries can only provide vaccine for one fifth of their population in the next year. In a world where global health is integrated with indigenous health, each of us should be deeply concerned about this. From the beginning of the epidemic, we are reminded that the rich countries bear in mind that any COVID-19 will pose a threat to the whole world. Before everyone can be vaccinated, there will be groups of patients. These patients will expand and spread. Schools and businesses will shut down again. The vicious circle of inequality will continue. It all depends on whether the world can work together to ensure that the scientific achievements achieved in 2020 can save as many lives as possible in 2021.
This kind of crisis related to human survival will affect all aspects of life. With the emergence of these historic moments, the solution is bound to have a ripple effect. Inclusive response can not only save lives and improve livelihoods, but also lay a solid foundation for building a stronger, more equal and more resilient post epidemic world.
It’s not too early to guard against the next pandemic

Bill: one of the questions I’ve been asked the most is when the world will return to normal. I understand why people ask this question. We all want to go back to the world before COVID-19. But there’s one area that I hope we’ll never go back in time, and that’s our complacency about the pandemic.
The cruel reality is that COVID-19 will not be the last pandemic we are facing. We don’t know when the next outbreak will come, or whether it’s a flu, coronavirus or other new disease we’ve never seen before. But we have to be prepared not to be caught off guard. Unless the whole world acts in advance, the threat of the next pandemic will still haunt mankind.
Fortunately, we can prepare for the outbreak of infectious diseases. Although the world has failed to prepare for COVID-19 in many ways, we still benefit from past experience in combating other infectious diseases. For example, the Ebola epidemic has made us realize the need to accelerate the development of new vaccines. So the Gates Foundation, in collaboration with the government and other funders, created the Innovation Alliance for epidemic prevention (CEPI). CEPI has funded the development of a number of new crown candidate vaccines, including those developed by Moderna and those developed by Oxford University in collaboration with AstraZeneca. CEPI is also deeply involved in the fair distribution of vaccines mentioned by Melinda.
In order to prevent the recurrence of last year’s difficult situation, we must pay as much attention to the prevention of pandemic as we do to the threat of war. The world must invest more in R & D and organizations like CEPI, which will help fight COVID-19, and we need to strengthen our capability that we do not yet have.
Preventing the next global pandemic requires tens of billions of dollars a year, which is really a huge expense. But novel coronavirus pneumonia is expected to cause economic losses of $28 trillion worldwide. The tens of billions of dollars spent in the world can save tens of billions of dollars and avoid millions of deaths. I think this is the best and most cost-effective insurance available in the world.
Most of the investment came from rich countries. Low and middle-income countries and foundations like ours can play a role, but governments in high-income countries need to take the lead, because they will benefit a lot from it. If you come from a rich country, your government’s contribution to global epidemic prevention will also benefit you. As Melinda mentioned, novel coronavirus pneumonia anywhere in the world will threaten the whole world, and the next global pandemic is also the same. Tools and systems to cut off the spread of the virus need to be universal, including in low – and middle-income countries.
For novel coronavirus pneumonia, the government must continue to invest in the essential scientific tools of the epidemic even after we beat the new crown pneumonia epidemic. New breakthroughs can help us take advantage of the next time we fight a new disease. It took several months for the United States to build up enough detection capability, but in fact, it is possible to improve the rapid detection capability in a short time. Before the next pandemic, I hope we can build a global super large diagnostic platform that can detect up to 20% of the global population every week.
■ laboratory technicians insert cotton swabs into the rapid detection instrument for new coronavirus / Getty pictures & Angus mordant
I believe that the next time we face a pandemic, we will have a better treatment. Monoclonal antibody (mAb) is one of the most promising therapies in neocrown therapy. If patients can get this treatment in time, the mortality rate is expected to drop by 80%.
For more than a decade, the Gates Foundation has been funding monoclonal antibody therapy to explore its potential for treating influenza and malaria. These antibodies can be used to treat a variety of diseases, but the disadvantage is that R & D and production are very time-consuming. It may take another five years for us to improve the technology so that it can be quickly applied to fight new pathogens.
In the novel coronavirus pneumonia, the capacity of our new vaccine will also advance rapidly in the next five years, mainly due to the successful development of the new crown pneumonia mRNA vaccine. In my annual summary “2021, the world is bound to make progress”, I introduced the mRNA vaccine in detail. In short, the mRNA vaccine is a new type of vaccine, which can give instructions to the human body to teach it how to resist a pathogen. Although the foundation has been funding the research of this new technology platform since 2014, it was not until last month that a mRNA vaccine was approved for the first time. This epidemic has greatly accelerated the development process of mRNA vaccine platform.
Just as I believe that great progress will be made in detection methods and monoclonal antibody therapy, I believe that in the next 5-10 years, the research and development of mRNA vaccine will be faster, the production will be easier to scale, and the storage performance will be more stable. This is a huge breakthrough for the future of global pandemics and other global health challenges. The technology platform of mRNA vaccine also has great potential in the research field of AIDS, tuberculosis and malaria. Perhaps the development of novel coronavirus pneumonia vaccine will become a weapon for us to end these deadly diseases.
Scientific tools alone are not enough to prevent global pandemics. There is also a global need for grassroots capabilities that can monitor dangerous pathogens in real time, as well as grassroots health forces that can be quickly activated in emergency situations. Details of this need to be considered, including where to build such a primary health force, how to design the organizational structure, and so on. But now I have some preliminary ideas:
First of all, we need to find the outbreak of the disease in the first time, no matter when and where. This requires the establishment of a global early warning system, which is not large enough. The cornerstone of this system is diagnostic testing. Suppose you’re a nurse in a rural health clinic, and you notice that there are more patients coughing than at this time of year, or that the number of patients dying is higher than usual. So, you did a test for common pathogens. If the test results are negative, your samples will be sent to other places for sequencing and further investigation.

Suppose you’re a nurse in a rural health clinic, and you notice that there are more patients coughing than at this time of year, or that the number of patients dying is higher than usual. So, you did a test for common pathogens. If the test results are negative, your samples will be sent to other places for sequencing and further investigation.
A novel coronavirus pneumonia Kit / Diagnostics lab in Kumasi, Ghana is being installed in the staff of the Kat Kha Masa diagnostic laboratory.
If your sample is found to be a super infectious or unheard of pathogen, the emergency response personnel of infectious diseases will take action. These people are like a fire brigade fighting a pandemic. Like firefighters, they are well-trained professionals, ready to deal with potential crises in a short period of time. When there is no outbreak, these people can work on prevention and control of infectious diseases such as malaria and poliomyelitis to maintain a high level of skills. I estimate that there will be about 3000 emergency personnel needed around the world.
In order to learn how to make the best use of these emergency personnel, the world needs to conduct scenario simulation exercises frequently. In the simulation, we need to exercise, analyze and improve the ability to deal with the outbreak of the epidemic, just as we use military exercises to improve the actual combat ability. Speed is key during a pandemic. The faster the speed, the earlier the exponential transmission of the virus can be cut off.
Those places that have fought against respiratory disease outbreaks in recent years, such as Taiwan, which has suffered from SARS, and South Korea, which has suffered from Middle East respiratory syndrome (mers), have responded faster than other regions in this outbreak because they have already experienced it. The exercise will ensure that everyone will act quickly when the next outbreak comes.
At the end of the day, the most important and simple reason why I’m optimistic that we can be prepared next time is that the world has understood that pandemic should be taken seriously. The world has realized that infectious diseases can kill millions of people or paralyze the global economy. The suffering of the past year will leave a permanent mark in the memory of a generation. I believe that all efforts to ensure that tragedy does not recur will be widely supported. We have seen the introduction of new pandemic prevention strategies, including those proposed by the G7 led by the UK last year. I expect more and more initiatives to emerge in the coming months and years.
When the novel coronavirus pneumonia came, the world was not ready. I believe it will be very different next time.
A brighter and healthier future for all
At the moment when the new crown is rampant, many people are still suffering. It is difficult to predict when the epidemic will end. And when that moment finally comes, history will remember the outstanding leaders who emerged in the epidemic, because they led us out of this crisis.
Leaders include not only those policy makers or government officials who are responsible for organizing the government’s anti epidemic actions, but also medical staff who have gone through hardships and worked hard in the front line; teachers, parents and caregivers who ensure that children will not leave their homework; scientists and researchers who work day and night to study how to stop the virus; and those who are willing to cook more meals to make their neighbors feel uncomfortable A kind man who will starve.
The leadership they show will lead us out of the epidemic. Thanks to them, the world can recover. After the recovery, the world will become stronger and better prepared for the next challenge. In the past year, the epidemic has threatened almost everyone in the world. We hope that by the end of next year, fair and effective anti epidemic measures will also benefit everyone.
I wish you and your family and friends peace and health in this difficult time.