18,328 Gates Notes, LinkedIn, Bill Gates

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Innovation and Inequity | 2021 Goalkeepers Report

Last year, we feared the worst when it came to the Global Goals. But even amid the devastation of the COVID-19 pandemic, we’ve seen that hope can grow from seeds planted years earlier. Here’s what we’ve learned.

A year ago, we sat down to write an unusual Goalkeepers Report. After years of steady progress on the United Nations’ Sustainable Development Goals (SDGs), the first wave of the COVID-19 pandemic was devastating families, health systems, and economies. We feared it was triggering an unprecedented reversal of progress across nearly every measure of health and prosperity that we track each year in this report.

Indeed, it has been an unprecedented year: Millions of people around the world have died from COVID-19. Millions more have felt the shocks of a global economy in crisis. And still the pandemic rages, with ever more contagious and severe variants spreading around the globe.

In so many ways, the pandemic has tested our optimism. But it hasn’t destroyed it.

Under the most difficult circumstances imaginable, we’ve witnessed breathtaking innovation. We’ve seen how quickly we can change our behavior, as individuals and as societies, when circumstances require it.

And today, we can also report that people in every part of the world have been stepping up to protect the development progress we’ve made over decades—when it comes to the SDGs, at least, the impact of the ongoing COVID-19 pandemic could have been far worse.

It has been a year that has reinforced our belief that progress is possible but not inevitable. The effort we put in matters a great deal. And, as impatient optimists, we believe we can begin to learn from the successes and failures of the pandemic so far. If we can expand upon the best of what we’ve seen these past 18 months, we can finally put the pandemic behind us and once again accelerate progress in addressing fundamental issues like health, hunger, and climate change.

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What the So-Called Miracle of Vaccines Shows UsN
ew vaccines usually take about 10 to 15 years to make. So, the development of multiple high-quality COVID-19 vaccines in less than a year is unprecedented.

And it’s easy to see why that might seem like a miracle. But in fact, the COVID-19 vaccines are the result of decades of careful investment, policies, and partnerships that established the infrastructure, talent, and enabling ecosystem needed to deploy them so quickly.

We have scientists around the world to thank for their years of foundational research. One researcher, Hungary’s Dr. Katalin Karikó, dedicated her career to studying messenger RNA, also known as mRNA. For years, her unorthodox ideas failed to gain broad support and funding, and many dismissed the idea that mRNA could be used to make vaccines and therapeutics. But Dr. Karikó persevered. Her story is emblematic of the many scientists whose discoveries—often years in the making—have made it possible for two highly effective mRNA vaccines to be developed in less than one year.

It’s a gift that will keep on giving: There are already mRNA vaccine candidates in the development pipeline that could finally tackle some of the world’s deadliest diseases, from malaria to cancer.

Of course, mRNA vaccines aren’t the only R&D success story to come out of this approach.

The long-term promise of genomic sequencing

By now, the whole world is keenly aware that SARS-CoV-2, the virus that causes COVID-19, has mutated into increasingly infectious and deadly variants, like delta, as it spreads around the world. Thanks to genomic sequencing—identifying the unique genetic makeup of a virus—scientists have been able to identify and track emerging variants.

Historically, the majority of the genomic sequencing in the world has taken place in the United States and Europe. Countries without sequencing technology would send viral samples to labs in places like New York and London for genetic analysis—and they’d only get results months later.

But for the past four years, organizations have been investing in building a genomic surveillance network in Africa, so countries on the continent could sequence viruses like Ebola and yellow fever. The Africa CDC established the Africa Pathogen Genomics Initiative, and when the pandemic hit, the nascent network turned its attention to SARS-CoV-2. The only reason the world knew that the more infectious and deadly beta variant had emerged in South Africa was because the country had invested heavily in R&D—in this case, pairing genomic sequencing capabilities with clinical trials and immunology studies. South Africa’s own Dr. Penny Moore was one of the first scientists to discover that a coronavirus variant identified in South Africa could circumvent the immune system.

With this information, public health officials around the world could plan accordingly. And South Africa, which has also invested deeply in infrastructure to rapidly and effectively conduct clinical trials, could

quickly adjust its vaccine trials. They began working to determine whether COVID-19 vaccines provided sufficient protection against the new variant that would soon spread everywhere.It’s insufficient for rich countries to be the only ones with the equipment and resources to sequence viruses.

It seems obvious that in a globalized world, where people and goods move constantly across borders, it’s insufficient for rich countries to be the only ones with the equipment and resources to sequence viruses. But it took a pandemic to reinforce how important it is to support the ability of low- and middle-income countries to collect and analyze their own data—because it benefits everyone.

And what’s particularly exciting about Africa’s genomic sequencing network is that the technology works for any pathogen: If the continent is able to keep building the network, it will soon be doing its own disease tracking for long-standing viruses like flu, measles, and polio.

Scientific innovation, even at a record-breaking pace, isn’t enough on its own. The COVID-19 vaccines are an amazing feat of R&D, but they are most effective when everyone has access to them. The inequities of the past year remind us that this is far easier said than done.

It’s up to people—from the halls of power to grassroots organizations and neighborhood groups—to step up to fill the gaps. And this year, it was these dynamic human interventions, when met with previous investments in systems, in communities, and in people, that allowed the world to avoid some of those initial, worst-case predictions.

Even Further, Even Faster

If the past year has shown us anything, it’s this: Simply addressing the crisis at hand means we’ll always be playing catch-up. To make future “miracles” possible, we need to think in generations, not in news cycles.

Long-term investments are rarely the exciting, easy, or politically popular thing to do. But those who have made them have seen meaningful returns amid a crisis of historic proportions. So many of the groundbreaking innovations of the past year have one thing in common: They grew out of seeds that were planted years—or even decades—earlier.

So, it’s clearer than ever that we need more governments, multilateral organizations, and foundations like ours to make forward-thinking investments, knowing that the returns might be many years down the road. We must work with others to support talented researchers around the globe to identify new tools and technologies that could be building blocks for solving a multitude of challenges. And we must strengthen collaboration across countries and sectors to work together toward common goals.

But it’s not enough for high-income countries to simply keep investing money and resources internally and hoping their game-changing innovations make their way to the rest of the world. We also need to invest in R&D, infrastructure, and innovation of all kinds closer to the people who most stand to benefit.

New sources of innovation

We’ve seen that COVID-19 vaccine access is strongly correlated with the locations where there is vaccine R&D and manufacturing capability. Latin America, Asia, and Africa are being hit particularly hard by the delta variant right now because so much of their population remains unvaccinated. Africa, in particular, has had difficulty getting access to the doses they need. The continent—home to 17% of the world’s population—has less than 1% of the world’s vaccine manufacturing capabilities. If African leaders, with donor support, invest in and build a sustainable regional vaccine development and manufacturing ecosystem, the continent would be far less likely to be last in line in a future pandemic.

That’s why we’re supporting the Africa CDC and African Union’s vision to do just that by 2040. It’s not only Africa that would benefit from improved health security and pandemic preparedness; the entire world would benefit from new sources of R&D and scientific innovation.

Africa is committed to establishing mRNA manufacturing on the continent, and already, mRNA companies are stepping up to make that a reality. This will allow Africa to create vaccines not just for COVID-19, but potentially also for malaria, tuberculosis, and HIV—diseases that disproportionately affect the most vulnerable.

Our call to invest closer to the source is a reflection of our belief in the ability of people all over the world to innovate and solve tough problems. The next big idea or lifesaving breakthrough can be sparked anywhere in the world, at any time. Whether the world will benefit is up to all of us.Responding to crises starts years before they happen.

It’s not difficult to imagine a world in which Dr. Karikó’s revolutionary ideas about mRNA never got the funding they needed. Or a world in which Africa didn’t have its own genomic sequencing capacity—and the beta variant couldn’t get sequenced in time to act quickly.

The pandemic has taught the world an important lesson: Responding to crises starts years before they happen. And if we want to be better, faster, and more equitable in our approach to realizing the Global Goals by 2030, we need to start laying the foundation. Now.

Read the full 2021 Goalkeepers report and explore the data to learn more.

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