However, it does not always get the attention its importance warrants, which is why having a day dedicated to health at Cop28 was a significant development. Mr Gates warned that attention to global health and the risks it faces has gone down. “I'm very worried that's going to create setbacks in health,” he said.
Speaking to The National, the co-chair of the Bill and Melinda Gates Foundation said: “Part of the reason we want to avoid extreme climate change is because it ruins people's health … even more important is the fact that the poorest in the world, who are farmers, barely growing enough food every year, they're going to have their crops fail, and so their kids will be malnourished”.
Mr Gates warned that those children will then have “a very high death rate from diarrhoea, pneumonia, because when you're malnourished, that's when you're greatly at risk”. Mr Gates is a leading advocate for placing health at the heart of development and climate action.
“In the end, it's all about the human condition.”
While he voiced optimism on the innovations that have allowed for tangible progress on health deliverables, he expressed strong concerns about the potential for climate change to derail that progress. “Climate [change] is a headwind against the incredible progress we've made in health,” he said.
“We've done well, we've cut child death in half. And now, if we consider these climate issues, we can continue and cut those deaths in half again.”
Mr Gates was speaking before the Reaching The Last Mile forum – a global health initiative established by President Sheikh Mohamed in partnership with the Bill and Melinda Gates Foundation – where $777 million was pledged to defeat neglected tropical diseases and support 1.6 billion people.
At the forum, Sheikh Mohamed announced a further commitment of $100m, which was matched by the Gates Foundation. The funding represents a five-fold increase over the contributions made to the initiative at its launch. The expansion will increase the reach of the fund from seven countries to 39 across Africa and Yemen, with the audacious goal of eliminating two diseases – lymphatic filariasis and onchocerciasis (river blindness) – from Africa.
Cop28 is a historic moment for the focus on health as part of the climate agenda, as the first such summit to dedicated a full day – December 3 – to health-related issues, with world leaders, including World Health Organisation director general Dr Tedros Ghebreyesus, attending the summit.
“One thing that's very important is that when you have so many people here, you could think climate was the only issue, and you shouldn't buy vaccines, or you shouldn't buy medicine for HIV or malaria bed nets,” Mr Gates said.
Strong progress being made at Cop28
Mr Gates also commended the UAE for hosting the climate summit, saying: “It's been a great meeting … we made a lot of progress because the meeting was very well run.”
He has been sending a clear message on the importance of maintaining funding for global health, at a time when resources are stretched and demand is increasing.
“These aid budgets that the climate money comes from are very limited, and so to have people remember, in the end, even if we solve climate [issues], if we start giving vaccines, that's not good, we need to do all these things,” he said.
Mr Gates acknowledged that there can be funding limits, which require prioritising. “If money is scarce, we have to prioritise the ones that are highly impactful, including, in the health area, things like vaccines, or these donated drugs that we get for neglected diseases. These are incredibly high-impact. And so you wouldn't want to divert this money away from the wonderful progress that we've made.”
Measuring impact is a key factor in determining funding. Mr Gates spoke of the “miracle of development impact”, particularly in the last two decades, that can be clearly measured.
“There's no field that does a better job of measuring its impact than health … we know that 10 million children were dying every year in the year 2000, and we know in 2019, we got that below 5 million,” he said.
The UN Sustainable Development Goals include a target of cutting that figure in half, to 2.5 million, by 2030.
“That goal was set before there was a pandemic, Middle East unrest, the Ukrainian war, and so we'll miss that deadline,” Mr Gates said. However, he added, the extent to which the deadline is missed “will depend on the donors remembering we're saving lives for very few dollars per life saved, and that we need to fund the vaccine fund, we need to fund the polio eradication”.
In addition to funding and measurement, continued innovation is vital. From developing a vaccine, to helping women survive childbirth, or children survive their childhood, or ensuring people are not malnourished and do not die from HIV. “This is a miracle,” Mr Gates said.
Health must remain a priority
Despite his optimism around innovation and solutions for reducing deaths from preventable diseases, Mr Gates is “hugely concerned” about global health getting lost as a priority on the global aid agenda.
“Because the rich countries aren't increasing their overall aid budgets in any significant amount, a lot of this ends up being a zero-sum game,” he said.
Asked about his greatest concerns, he said: “The Global Fund, which is the big funder for malaria and [tuberculosis], raised a bit less money last time. And next year, we have to raise money for Gavi [the Vaccine Alliance]” as part of its five-year fund-raising cycle.
“Because of so many other causes, and I'm not saying they aren't important causes, but Ukraine, including refugees and economic aid, whatever money helps reduce the Israel-Gaza difficulties, high interest rates that African countries are paying, climate mitigation, climate adaptation, climate loss and damages … so health funding is down from what it was.”
With all of these competing agendas, he said, it is important “not to defund something that is effective”.
One of the driving forces for improved health care globally, and particularly in developing countries, is innovation. Mr Gates stressed the importance of continued research and development, and an “R&D pipeline”, to maintain progress.
“We have actually two malaria vaccines, but they don't last long enough, so we need a next generation vaccine, that would be a great tool.”
Everything, from mosquito nets – which are still “the best buy” to prevent malaria – to vaccines, needs continuous improvement as diseases and their causes evolve, he said.