Bill Gates released his annual letter today. In it, he writes about polio eradication, vaccines in general, malaria, saving the lives of babies, the need for leadership on HIV, the promise of agriculture, excellence in teaching (in the US), and the Giving Pledge. He closes with a request for dialogue and engagement, reminding us all he has a twitter feed – @billgates and a new blog – www.gatesnotes.com. Other bloggers, I am sure, will provide detailed analysis and recaps of the letter. I’ll just offer some highlights from each section:

Polio Eradication

He cites three major benefits to polio eradication:  the immediate benefit of protecting children forever from polio, the money that will be saved by eliminating the need for treatment and the economic impact of people losing productivity – he cites a study that states it would save $50 billion over the nest 25 years. Finally, he argues that eradicating polio would be the kind of victory that proves the value of spending on global health. I am agree whole-heartedly with the first two benefits; I am less certain of the third.

Vaccines

Here, Gates mentions the hidden impact of vaccine-preventable diseases, specifically the impact on mental development. He mentions a study that ties reduced IQ on a national level to having a high national burden of disease. He calls it a loss of human potential, all before a child turns five.

Malaria

The section on malaria is almost entirely positive, pointing to good progress in reducing incidence of the disease. He does cite the fact that Turkmenistan become malaria free in 2010, which makes me tired. Turkmenistan’s had malaria cases in the single or double digits for a long time, and becoming officially malaria free was about administrative certification, not a public health breakthrough.

Neonatal Care

This is a brief section, and mostly what he points out is that saving babies in their first month of life is difficult. The causes of death in this age group cover a huge range, and it’s going to take a lot of donor support to bring reduce mortality rates.

HIV

This, I think, is the most critical section of the letter. Gates complains that a sense of urgency does not exist yet, and expresses concern over a slowing pace in the fight against AIDS.

Agriculture

In a brief but complicated section of the letter, he mentions rising food prices, praises the new World Food Programme initiative to buy food from small farmers, and once again mentions a Green Revolution in Africa.

Education in the US

He cites the low US performance in educating its children, and discusses the different approaches the Gates Foundation has supported to improve “excellence in teaching.” It’s a very Gates-foundation approach, focused on individual teachers and new technologies for education.

The Giving Pledge

58 people have now joined the giving pledge. And Gates believes that the United States is the most generous country in the world.

One final comment – in the section on HIV, Gates states that “If the United States had an epidemic where almost half the girls in large neighborhoods contracted a terrible disease, we would find a way to cut through all the complexity.” – I really, really, wish that were true.

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