On the sidelines of the United Nations General Assembly (UNGA) in New York, the Bill & Melinda Gates Foundation (BMGF) organized the Goalkeepers event which keeps track of progress on the Sustainable Development Goals (SDG). This year, the event is focusing on child and maternal mortality and revealing seven innovations that could save two million mothers and children by 2030. Mark Suzman, CEO of BMGF sat with journalists to discuss issues around he foundation’s priorities. Associate Editor, Seun Akioye was there
The Goalkeepers 2023 has just closed, what are your reflections about the event, what do you take away from this year’s Goalkeepers ?
It feels like coming to a press conference like this is almost a little bit anticlimactic after the energy, power, passion and the vision that I hope you all saw on stage and felt inspired and informed by.
But at the heart of it really is those two statistics that Bill Gates and Melinda French Gates shared during their session, Melinda talking about the 800 women a day who still die in childbirth and Bill talking about even as we recognize the amazing progress of the shrinking circle down from 10 million preventable child deaths a year in 2000 to 4 .6 million today. That is still 4 .6 million deaths that could be prevented. And you’ve also seen, and very concretely demonstrated, that the interventions needed to help save so many of those lives, to save an additional two million lives by 2030, are really simple, affordable, scalable.
This is not a rocket science problem. It’s not impossible, it’s something that is absolutely achievable. And it should be, in our opinion, the world’s highest priority. We have climate crisis, we have war, we have famine. We have all these issues. But at the heart of it, the most fundamental is simply, are people alive or dead? Can you help provide, if you can provide an intervention that helps a preventable death?
Surely that should be the highest collective goal. of all our human aspirations. When you have the sustainable development goals. They are a framework of 17 ambitious goals about people and planet.
The world needs to pay attention to all of them. But I would argue that the best proxy of how seriously the world is taking those goals is that most powerful one around preventable child and maternal mortality.
And the answer is, while we’ve made some progress, we are not putting in the political will, the resources, the scaling that is absolutely needed today. And so that’s why we’ve chosen to use this year, the midpoint of the SDGs to refocus on that.
Not to say it’s the exclusive area to focus, but to just illustrate again how concrete and tangible these things. It’s not just about numbers, it’s fundamentally about people. And it’s about then getting the political prioritization, getting the resource allocation, getting the support global, national, regional, right down to the community level, to the leaders, the change makers that you saw in the awards last night that you saw on the stage today.
Last year the Foundation made some commitments after the Goalkeepers. How far did you go with the commitments and are you making any strong commitments this year?
Well, the commitments, we do them in each of the areas that we work on. So, for example, for last year, some of the commitments we made were around big investments in gender equality, in climate adaptation, which actually I did go and then announce at the last Conference of Parties summit, and we come up with climate adaptation meaning really food security, agricultural development and related issues. And so yes, one of the things that we try to do as the Gates Foundation, and obviously we’re primarily a grant-giving organization, is that when we make our commitments, which are normally numerical dollar commitments around a set of interventions, we are very clear and strict about how we account and measure and then deliver and follow up on those.
So, some of it, for example, might be commitments we make in this case, in the sort of GAVI Vaccine alliance that Bill referred to. We do significant set of allocations into the broader maternal child health space and the reproductive maternal child health space. Just this week, for example, so when you’re asking about our newer commitments, yesterday Melinda was part of where we committed an additional $100 million for family planning commodities because family planning is actually one of the most critical interventions, and the UNFPA is facing significant constraints. We’ve also made another commitment of $100 million to UNITAID, which is a shared advice that works actually on a lot of these innovations, including in diseases like Tuberculosis and malaria research as well.
It’s more about us saying the model of how the world should be engaging these topics when you have the world leaders of state is to actually ask them to do the same. When you’re making a commitment, how many resources are you putting? How will we be measuring progress? How will you track it? How will we be able to measure it the following year?
I’m happy to go into any specific area, but I do think that’s one of the areas that we worry a little bit that in a UN General Assembly, when you have these events and you have the leader speaking, you’ll hear a lot of general commitments about, yes, we commit to invest more in health or we commit to more financial reform, but actually trying to make that concrete and measurable. That’s something we used to have a little bit more clearly at the UN and the MDG here and that used to be a tracking of government saying, well, here’s where we are in child mortality this year. Here’s where we expect to be next year. Here are our national resources. Here’s what we’re doing. And I think that focus on metrics, it’s why the back of our report always does track the 18 SDG indicators and targets that we feel are the most important because they’re connected ultimately to human lives and livelihoods.
There is a lot of worries about the Presidential Emergency Plans for Aids Relief (PEPFAR) fund and the fact that everyone is waiting on its re-authorisation. What is the implications of this on your programmes and the people who are directly affected?
Yes, so PEPFAR has come up a couple of times today. It was mentioned in the opening panel, it was mentioned by Nick Kristof. Hopefully most people are familiar with it, but this is the U.S. government-led president’s emergency program for AIDS relief, which really has been one of the signature issues that was launched by President Bush 20 years ago, and it really helped drive down the cost of antiretrovirals and has helped save tens of millions of lives.
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Combined with the Global Fund, and really from the AIDS Fund we look at the two of them together, the Global Fund to Fight AIDS, TB, and Malaria, of which the U.S. is also a large supporter. We’re a large supporter. But we would argue that the two together, along with the Gavi Vaccine Alliance for Adult Diseases, you know, have been arguably the most successful public-private partnerships of the last 25 years of any kind in any sector.
And so having PEPFAR now be at risk, which it is because some political leaders are implying that PEPFAR is being used to provide or support an abortion agenda, which many conservatives in the United States oppose, but that’s just factually untrue. The PEPFAR does not do that. It’s focused on saving lives and, you know, we hope and are confident and are using our voice, I’ll say cautiously confident, that actually the US will end up re-upping its support and providing the necessary resources to keep PEPFAR going as a signature initiative.
And it’s actually helped many of the recipient countries build stronger systems, as was mentioned, it actually builds stronger relationships between the countries. And so if that’s a threat, then it’s difficult to build the big new coalitions that the world needs across these other broader health interventions and in other areas like education.
We are talking about human capital interventions. So it shows you how different and how challenging the space is right now in terms of at least getting what is traditional high-income support into these high-impact interventions. But it makes it more important, too, that the global South, and particularly African leaders also speak with a unified voice about their needs and their priorities and making clear that this is what they’re expecting from not just traditional donors but the multilateral development banks, other global support like the World Health Organization.
So yes, we’re concerned. I feel confident PEPFAR will actually be reauthorized, but it’s a sign of how challenging the global environment is to get resources for something that is so self-evidently a great public good.
There’s a quite a big focus on midwives in this Goalkeepers meeting. How do you see the situation in terms of those who are practicing in the developing countries, and also in terms of training more midwives?
Certainly you’ve heard there was both an award last night, and one of the great presentations this morning and midwives are essential. Well, amazingly, personally, I found those two of the most inspiring of the stories. And they are an essential part of the overall workforce. And certainly for maternal child health care. They’re an essential part of it.
Broadly, though, they are components of a larger, successful primary health care system. One of the things that needs to be done for all these health interventions is to make sure that primary health care is properly funded and supported, which includes the training of health care workers. That’s a whole cadre of different activity that President Ruto of Kenya talked about, you know, his announcement next week on community health workers, but midwives, community health workers, other nurses, and then also, obviously, training of doctors and other medical personnel are all critical components along the continuum of that. But I wouldn’t want to single out, you know, in particular, they’re obviously critical for what today’s topic was, which is really around reproductive, maternal and neonatal health, and they are the critical intermediaries.
But it’s a broader question about ensuring that health workers across low and middle income countries are well trained, properly paid, able to work in facilities where they have the supplies. You also heard from today’s midwife that she occasionally had to use her own money to purchase supplies because they were stockouts. That clearly is not something we should be asking midwives or nurses to do. We need to have functional supply chains, and that’s eminently possible to do even in the lowest income countries.
A lot of issues could be responsible for the poor statistics on health and maternal mortality, one is poverty and then government policy. Is there a way the foundation is working with national governments for policy stability?
Over the last 20, we’ve seen 20 years of steady decline in malaria cases. They’ve flattened and they’ve slightly increased. Similarly, with tuberculosis, HIV, AIDS, these are all diseases which also halved as did child mortality in the first two decades of the 21st century that have now flattened or begun to reverse. That’s part of a broader issue where we feel at a government level and at a global level, there just hasn’t been as much focus back on the basics of health interventions. And some of it bluntly is about money, as I said on my panel. It’s a resourcing issue. You need to make sure that PEPFAR or the Global Fund or other issues are able to come in and be fully funded for the purchasing. And it is at a national level.
Nigeria, for example, we work across multiple countries in Africa and Asia on all of these issues. But one of the things we say is you should prioritize, even countries with strong budget constraints should be prioritizing health and education and human capital in their investment. Nigeria does have, but you actually heard from the professor, I think it’s, we’re comfortable saying, your new health minister, Minister Pate is an old friend and partner of the foundation and many he has spent time at the World Bank himself and elsewhere. We think that there should be more domestic resources invested in basic health care in Nigeria, in Kenya, in Pakistan, in Bangladesh, however. We think it’s a very high return on investment.
The challenge with the return on investment is that it’s a 25 year return on investment because you’re investing in a healthy child that will grow up, you hope to be a healthy, well-educated adult, but that’s not the time frame most politicians operate on. And so that’s why health and education tend to be systematically underfunded. So it is a combination of, yes, it’s the policy prioritization. So we do work with, again, a lot of the work is the World Health Organization or partners in Africa, like the Africa CDC or UNICEF. These are countries that work across all of these issues and we are strong supporters and funders of all of them.
And then we’ll often work at the national level with a number of countries, including Nigeria or Ethiopia or Kenya or Pakistan or India on specific policies and interventions that make the most sense in that country. But again, as a foundation, it’s important to emphasize our goal is not to provide service delivery at scale. We’re there to try and capitalize innovations of the kinds that you’ve heard today, showcase best practice and exemplars, help demonstrate what the rest policies are. We can use our convening and our voice to showcase it. But in the end, the ultimate responsibility to accountability has to be the national and local governments but we believe with appropriate support from international agencies and from the global north.
During the pandemic, there was so many conspiracies surrounding Bill Gates and the foundation. To what extent has been affected by this rumors and conspiracy theories and how do you deal with them?
Just starting on the conspiracy theories. It’s a broader issue where we know during COVID there’s a huge amount of misinformation and disinformation about vaccines generally. Yes, some of that involves very strange allegations about the Gates Foundation.
I don’t believe it’s fundamentally affected our work or our ability to partner. And I think that it is a symptom of a much wider global challenge about ensuring there is this robust, detailed, fact-based, science-based reporting that help the public who otherwise might be susceptible to some of this disinformation to understand what is appropriate. And when there are fundamental untruths, it can be actively damaging and cost lives.
In terms of the broader interventions on supply chain or areas beyond maternal child health, absolutely. The Gates Foundation works across a large set of areas. Our biggest area is global health. But that does include across reproductive maternal child health, includes infectious diseases like HIV, TB and malaria. It has a very big nutrition component. And you heard about some of the probiotic research there, but that extends well beyond that. Some of the micronutrient supplements that you also heard there, but these are broader. You can have supplements, nutritional supplements built into all foods. So iodine supplements in basic staples and other tools like that.
We work across all of that. We work across agricultural development. We work in areas like financial inclusion, sanitation. In each of those, we pick areas where we think there is a particular opportunity where our philanthropic capital can make a big difference, either by identifying a particular innovation or intervention. Or we see a disproportionate impact on the poorest and most vulnerable because that’s our mandate is to focus on them. And then we do work to then find models that are going to be scaled and sustained.