Bill Gates makes two big predictions for global healthcare in Cambridge Union speech

paul.brackley@iliffemedia.co.uk

Published: 13:37, 07 October 2019

| Updated: 23:03, 07 October 2019

Bill Gates has told the Cambridge Union that millions of lives will be saved by solving the global problem of malnutrition in the next two decades.

The billionaire philanthropist, who co-founded Microsoft, said it was the “greatest health inequity in the world”.

Bill Gates, co-chair of the Bill & Melinda Gates Foundation, speaks after receiving the Professor Hawking Fellowship 2019 at the Cambridge Union. Picture: Luke MacGregor (18774861)

He said: “Many of the technologies that will shape human health two decades from now are already in development. And recent breakthroughs in understanding about how the body works are setting us up for huge improvements.

“I’m lucky that my work gives me a view of all the amazing discoveries in the works right now. That’s why I’m able to predict the future. Based on what I see coming down the pipeline, I predict that human health will be dramatically altered by two major developments over the next 20 years.

“My first prediction is, we will solve malnutrition and significantly reduce the number of nutrition-related deaths.

“I get asked a lot what I would choose if I could only solve one problem. My answer is always malnutrition.”

Mr Gates was speaking on Monday morning (October 7) after being named the 2019 recipient of the Professor Hawking Fellowship, founded by the Cambridge Union Society in 2017 in honour of Prof Stephen Hawking’s contribution to Cambridge.

Prof Hawking delivered the inaugural fellowship lecture on November 23, 2017, in what was to prove one of his last public appearances before his death on March 14, 2018, aged 76.

Mr Gates, who now tackles global health issues and inequality through the Bill and Melinda Gates Fellowship, said: “I’m lucky to have known Professor Hawking. We first met in 1997, when I was here to announce a new research lab that Microsoft opened with Cambridge. We saw each other several times over the years - both here in Cambridge, and in Seattle for some particularly memorable dinners. I wish I could tell you something surprising about our conversations, but we mostly talked about physics.”

Professor Stephen Hawking in March 2015. Picture: Andre Pattenden

He described Prof Hawking as “exceptional in person as you imagined he was”, adding: “He not only had a brilliant mind for physics, but he was also a remarkably gifted communicator.”

He said he wanted to try to answer one of the big questions Prof Hawking posed: Can we predict the future?

“When it comes to the future of health, I believe the answer is yes - we can,” he said.

Pointing to global health improvements in recent decades, and medical innovations, as a reason to be confident about the future, he spoke about the need to solve malnutrition not just to cure prevent children’s growth and development being stunted.

“It’s no exaggeration to say that stunting holds back entire nations,” he said.

In addition to providing fortified foods and supplements, treating illnesses and aiding of maternal health, he said there was another component to solving malnutrition: Understanding the community of bacteria in our bodies known as the microbiome.

“Until recently, fixing the microbiome has been a complete mystery to us. We’ve learned a lot about it in recent years, and will continue to learn more over the next two decades.

“That deeper understanding is why I predict we’re going to solve malnutrition.”

He added: “In the future, we’ll be able to create next-generation probiotic pills that contain ideal combinations of bacteria - even ones that are tailored to your specific gut.

“Another intervention could be what’s called microbiota-directed complementary foods. Think of them like fertiliser for the microbiome. Eating them encourages healthy bacteria - the ones that help digest food and protect us from infection - to flourish.”

Mr Gates made a second big prediction about the shape of global healthcare.

“Over the next 20 years, I predict that every nation on the planet will have broadened its healthcare focus from just saving lives to also improving lives.

“This transition marks the single most significant change in how a country thinks about healthcare.”

Contrasting how someone living in Britain has access to a doctor for check-up and to discuss risk factors for disease with those in Chad, who “might never see a doctor, only a nurse or another health worker” unless something is seriously wrong, he said: “What’s the difference between these two approaches? In the UK, the goal of healthcare is to keep you healthy. In Chad, the goal of healthcare is to keep you alive.

“It seems like a subtle difference, but it has a huge impact on how you approach healthcare. Within two decades, I believe every country on earth will be able to focus on not just keeping you alive but healthy and well.”

He said the number of countries where the percentage of preventable deaths was above 50 per cent would continue to fall.

“Right now, all of the countries where the majority of deaths come from these preventable causes are in Africa,” he said. “Two decades from now, those countries will have crossed the 50 per cent threshold.”

Mr Gates explained that he could be confident about this because of advances in understanding of malaria - an area of focus for the Bill and Melinda Gates Foundation, which is dedicated to improving global health.

“I believe we’ll also have virtually eliminated malaria by 2040,” he said.

“For a long time, we thought treatment was the best approach.

“The reality is a lot more complicated. What we’ve learned in recent years is that the key to stopping malaria is vector control - and for malaria, the vector is mosquitoes.”

Controlling mosquitoes was now more feasible because we had better knowledge of where they are, he explained.

“I’m also excited about the potential of gene editing,” he added. “Eliminating all the mosquitoes in an area is the quickest way to stop malaria, but it’s risky. Most mosquitoes can’t carry the malaria parasite. If you got rid of them, you could disrupt the local ecosystem.

“Gene editing lets us target only the bad malaria-carrying mosquitoes. Inserting a gene that prevents these bad mosquitoes from reproducing would buy us time to cure all the people in an area of malaria. Then we could let the mosquito population return without the parasite.

“This technology is still in the testing phase. We need to understand things like: What’s the impact on the food chain if even one species of mosquito starts dying off? How many altered insects would we need to introduce? How long do we need the mosquitoes to be gone? And what political and governmental hurdles do we need to clear?”

Mr Gates also predicted we would “turn the tide of the HIV epidemic” thanks to improved drugs and better prevention strategies, plus the prospect of a future HIV vaccine - something University of Cambridge research could help create.

As the number of preventable deaths falls, the prevalence of chronic conditions, including mental illness, would rise, he pointed out.

But he said: “Innovation is shrinking the gap between perfect and not perfect health for everyone. And the smaller it gets, the better the world becomes.

“That’s because the shift from longevity to wellness doesn’t just change how we approach healthcare. It unlocks all sorts of amazing opportunities for people and societies to thrive.

“Improvements in health are fundamental to lifting people out of poverty. When you improve health, people are more productive. And when more children survive to adulthood, families decide to have fewer children - which can lead to a burst of economic growth.

“In other words, when people thrive physically, economies grow. Poverty goes down. The world gets better.”

He said countries had to invest in healthcare innovation.

“The world is at a critical moment for global health. There are a number of key programs that need to be funded. Nations are deciding right now whether those investments are worth making.”

And he ended by reminding everyone of what Prof Hawking had taught the world.

Thanking the Cambridge Union for the “tremendous honour” of the fellowship, he said: “Professor Hawking believed in the magic of science and research. He helped the rest of the world believe in it, too. As remarkable as his contributions to the field of physics were, I believe this is his biggest accomplishment.

“He reminded us to 'look up at the stars and not down at our feet’. He taught us all that, if humanity remains focused on expanding what is possible, progress will come.”