This text is an excerpt from the annual letter from Bill Gates, co-chair of the Bill & Melinda Gates Foundation and founder of Breakthrough Energy, originally published in The Gates Notes.
When you think about 2023, how will you remember it?
For me, this will always be the year I became a grandfather. It will be a year of spending quality time with my loved ones, be it on the pickleball court or playing Catan. And 2023 was also the first time I used AI for work and other serious purposes, not just goofing around and making parodies of song lyrics for my friends.
This year we got a glimpse of how AI will shape the future, and as 2023 comes to a close, I'm thinking more than ever about the world that today's young people will inherit. In my letter last year, I wrote that the prospect of becoming a grandfather made me think about the world my granddaughter would be born into. Now I think more about the world he will inherit and what it will look like in a few decades when his generation is in charge.
And I can imagine it: the tools you will use, the means by which you will connect with your loved ones, the problems that all these innovations will help solve… Today we have a clearer idea of these types Tasks that the AI can do for itself and those where it will act more as a co-pilot. And we are seeing more clearly than ever the extent to which AI can be used to improve access to education, mental health care, and more. I am motivated to advocate for this technology to help reduce (rather than increase) the terrible inequalities we see around the world. I have always believed strongly in the power of innovation so that all boys and girls have an equal opportunity to survive and thrive. And AI is no exception.
My heart breaks at the incessant suffering of Israelis and Palestinians and the people of Sudan
The first years of a new era are usually characterized by numerous changes. If you're old enough, think about the early days of the Internet. At first you probably didn't know many people who used it, but over time it caught on until one day we realized that most people already had email addresses, bought things online and used search engines. to answer your questions.
Well, today we are at the beginning of a similar transition. It's an exciting and confusing time, and if you still don't know how to get the most out of AI, know that you're not alone. I thought I would use AI tools for the Foundation's strategic reviews this year (which require reading hundreds of pages of reports that an AI could summarize with great accuracy); But customs are stubborn and in the end I prepared them as usual.
Of course, AI is far from the only defining element of 2023. Millions of people continue to suffer unbearable pain following Russia's war against Ukraine and the Ethiopian War. My heart breaks at the ceaseless suffering of the Israelis and Palestinians and the Sudanese people. At the same time, climate change means that more and more people are being affected by extreme weather events that are occurring more and more frequently. And families around the world continue to suffer the cruel consequences of rising inflation and an economic slowdown.
Of course we live in difficult times, but I remain optimistic about the future
Of course we live in difficult times, but I remain optimistic about the future. Innovation has never developed so quickly. We're making breakthroughs on complex problems – like Alzheimer's, obesity and sickle cell anemia – that will improve the lives of millions of people. My late friend Hans Rosling used to say: “Things can be bad and get better at the same time.” It is a good reminder that progress is not only possible, but happens every day.
Through my job, I am fortunate to stay up to date on how the world is improving. The challenges we face seem much less daunting when you know exactly what it will take to overcome them. In this letter I will share some reasons for my optimism about the coming year: I hope they will help you share with me my excitement about all the progress the future holds for us.
Innovation development will increase rapidly thanks to AI
My work has always been based on one central idea: innovation is the key to progress. That's why I founded Microsoft; and that's why Melinda and I founded the Gates Foundation more than two decades ago.
It is thanks to innovation that our lives have improved so much in the last century. From electricity and cars to medicine and airplanes, innovation has given us a better world. Thanks to the computer revolution, we are much more productive today. And the wealthiest economies are moving forward, powered by innovative industries that are evolving to meet the needs of a changing world.
But my favorite story begins with one of my favorite statistics: Since 2000, the number of boys and girls dying before their fifth birthday worldwide has halved.
And how do we achieve it? Mainly thanks to innovation. Scientists have developed new ways to produce vaccines faster and cheaper, but just as safely. They developed new mechanisms to deliver highly effective vaccines in the most remote places in the world, allowing them to reach more boys and girls. And they have developed new vaccines that protect boys and girls from deadly diseases like rotavirus.
Since 2000, the number of boys and girls dying before the age of five worldwide has halved.
In a world with limited resources, we must find ways to maximize impact. Innovation is the key to getting the most out of every dollar spent. And artificial intelligence is about to accelerate the speed at which we make discoveries to an unprecedented pace.
One of the biggest impacts so far has been the development of new drugs. Drug discovery requires the analysis of massive amounts of data, and AI tools can significantly speed up this process. Some companies are already working on cancer drugs developed in this way. However, a key AI priority for the Gates Foundation is to ensure that these tools also address health problems that disproportionately affect the world's poorest, such as AIDS, tuberculosis and malaria.
It's impressive to see how much creativity comes to the table. Here is a small selection of some of the most ambitious questions currently being investigated:
● Can AI combat antibiotic resistance? Antibiotics don't have a magical ability to kill infections, but when used too often, pathogens can learn to ignore them. This is the so-called antimicrobial resistance (AMR), a phenomenon that is a serious problem worldwide, especially in Africa, where the highest mortality rates from AMR are recorded. Nana Kofi Quakyi from the Aurum Institute in Ghana is working on an artificial intelligence-based tool to help healthcare professionals prescribe antibiotics without contributing to antibiotic resistance. The tool reviews all available information (including local clinical guidelines and health surveillance data on pathogens at risk of developing resistance in the region) and suggests the most appropriate drug, dose and duration of treatment.
● Can AI provide a personalized tutor for each student? The educational AI tools currently being tested are incredible because they are tailored to each student. Some (like Khanmigo or MATHia) are already exceptional and will only get better in the years to come. One of the things that excites me about this type of technology is the ability to adapt it to any student, no matter where they live. For example, a team in Nairobi is working on Somanasi, an AI-based tutor aligned with the Kenyan curriculum. The name means “learning together” in Swahili and the virtual tutor was developed with cultural context in mind so that it will be familiar to the students who use it.
Tonee Ndungu, whose team develops Somanasi, presents the latest version of his personalized educational tutorial. Mwangi Kirubi (Gates Notes)
● Can AI help treat high-risk pregnancies?? Every two minutes a woman dies during childbirth. It's a scary statistic, but I hope AI can help. Last year I wrote an article about how AI ultrasound could help detect perinatal risks. This year I was excited to meet some of the ARMMAN researchers who want to use artificial intelligence to improve the prospects for new mothers in India. One day, his great language model will serve as a co-pilot for healthcare workers treating high-risk pregnancies. The model can be used in both English and Telugu and the best part is that it automatically adapts to the experience level of the person using it, whether it is a nurse who is just starting to learn, or a midwife with decades of experience.
● Can AI help people assess their HIV risk? For many people, discussing their sexual history with a doctor or nurse can be uncomfortable. But this is important information for assessing the risk of contracting diseases such as HIV and prescribing preventative treatments. A new South African chatbot aims to make HIV risk assessment easier. The bot acts as an impartial and unbiased advisor that can provide advice 24/7. Sophie Pascoe and her team are developing it specifically for marginalized and vulnerable populations who often face stigma and discrimination when seeking preventative care. Their findings suggest that this innovative approach can help more women understand their own risk and take the necessary steps to protect themselves.
● Can AI make medical information easier for all healthcare professionals? When treating a critically ill patient, it is important to be able to quickly access their medical history, for example to know whether they are allergic to a particular medication or have had heart problems in the past. In countries like Pakistan, where many people have no documented medical history, this is a major problem. Maryam Mustafa's team is working on a mobile voice application that could greatly facilitate the creation of medical records by maternal health workers in Pakistan. The app asks a series of questions about the patient and uses the answers to fill out a standard medical history. The idea is that providing more data to healthcare workers will improve pregnancy outcomes in the country, which are among the worst in the world.
Such projects still have a long way to go. There are significant hurdles to overcome, such as finding a way to expand the scope of projects without sacrificing quality, or providing adequate access to the backend to ensure they remain functional over time. But I am optimistic and think we will solve them. And honestly, it's extremely inspiring to see that so many researchers are already thinking about how all of these new technologies can be used in low- and middle-income countries.
In high-income countries like the United States, AI usage among the general population will not reach significant levels for another 18 to 24 months.
Global health has a lot to teach us about how to make AI more equitable. The most important lesson is that the product must adapt to the people who will use it. The medical records app I mentioned is a good example: In Pakistan, people usually send each other voice notes instead of text messages or emails. It therefore makes sense to create an app that does not have to enter long instructions using the keyboard, but relies on voice commands. And the project will be designed directly in Urdu, so there will be no translation problems.
If we invest wisely today, AI can make the world a fairer place and reduce or even eliminate the gap between the rich world's access to an innovation and the poor world's access to an innovation.
If I had to make a prediction, I would say that in high-income countries like the United States, it will take another 18 to 24 months for AI usage in the general population to reach significant levels; I expect we will see similar levels of usage in African countries in about three years. The gap still exists, but it is much smaller than what we have seen with other innovations.
On the verge of long-awaited progress against malnutrition
I'm often asked what I would choose if I could solve a single problem. And my answer is always the same: malnutrition. It is the world's largest health disparity, affecting one in four children. If you don't get enough nutritious food in the first two years of life, you won't develop properly physically or mentally. Fighting malnutrition can help us reduce one of the main factors contributing to child mortality.
The causes of malnutrition are much more complex than a simple lack of food. About 15 years ago, researchers began focusing on the bacteria living in the gut (called the microbiome) after finding that some oral childhood vaccines, such as polio, were less effective in places with high rates of malnutrition. It seemed that something was preventing it from being recorded correctly.
All of the children in this photo are nine years old, but the middle three are well below average height for their age due to their stunted growth. The Gates Notes, LLC
This suspicion was confirmed in 2013 when biologist Jeff Gordon published a groundbreaking study of the microbiome of twins from Malawi. It turned out that the microbiome is not just a consequence of health, but a decisive factor. This was the first big clue that if we could change the gut microbiome, we could reduce malnutrition rates.
In the last decade we have learned more about the gut microbiome than in the previous thousand years. For example, we have found that bacteria living in the gut can be in a disordered state and can cause inflammation, preventing the absorption of nutrients. And we also found that the gut microbiome improves much more with timely intervention
Phase 3 trials are currently underway with a powdered dietary supplement containing B. infantis bacteria that can be added to breast milk.
One of the first intestinal bacteria to appear in human development is called B. infantis. This bacteria helps break down the sugar in breast milk into nutrients the body needs for growth. And breast milk, in turn, provides nutrition for B. infantis and the entire gut microbiome. It's a virtuous circle. However, if a baby does not have adequate levels of B. infantis bacteria to begin with, he or she may not absorb the nutrients from breast milk that are necessary for the growth of other vital gut bacteria.
And that is a deficit that is difficult to overcome. You can access all the nutrient-dense foods in the world, but it won't do you any good. If your gut deviates from its growth path prematurely, you may never be able to absorb all the nutrients you need again.
But what if we could give B. infantis as a probiotic supplement to at-risk infants? Could we intervene early enough to get them on the right path?
This is exactly what a number of foundation partners have been researching for years, and we are finally close to finding an answer. Phase III trials are currently underway with a powdered B. infantis supplement that can be added to breast milk. The study involves 16,000 babies from five countries, and researchers are tracking each one to ensure the probiotic is safe and effective.
The results so far are amazing: the microbiome of babies taking this probiotic reaches a positive state that allows them to grow and reach their full potential. This could be an extremely useful tool for preventing malnutrition.
While clinical trials are ongoing, the foundation's partners are also working to reduce production costs. It is important that probiotics are affordable so that they can be widely used in low-income countries where malnutrition rates are highest.
The next step is (hopefully) greater regulatory approval and high-quality, reliable production on a larger scale. I am optimistic about ongoing research to develop alternative formats, such as a liquid version that could be given directly to infants without having to be mixed with breast milk. I am also fascinated by the possibility of improving the intestinal microbiome before the baby is born. Treating uterine inflammation may have additional benefits for the woman, the placenta, and the developing fetus.
What if expectant mothers could take a probiotic supplement that would have positive effects on their child's gut? This is very early research and it's not yet clear exactly what these live biotherapeutic drugs would look like or how they would be administered, but studies show that a healthy microbiome could help babies gain five more grams per day in the final weeks of the pregnancy Pregnancy.
Over the last decade, the field of children's health has evolved faster than ever before, reaching heights I never thought I would see in my lifetime. It was incredible to see how the microbiome went from something completely invisible to a key element in tackling one of the world's greatest health inequalities. I can't wait to see what more we'll learn in the next year – and how we'll use all that knowledge to save lives.
I wish you and your loved ones a wonderful New Year.
Bill Gates
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