Bill Gates: What I learnt from my Kenyan trip

Bill Gates returned to Kenya last week on Monday, November 14, after 12 years.

Gates spent time with a chicken farmer in Makueni, visited scientists at the Kenya Medical Research Institute and met President William Ruto, among other activities.

He also announced the Bill and Melinda Gates Foundation, which he co-chairs with Melinda French Gates, will spend $7 billion (Sh855 billion) in Africa over the next four years.

Gates fielded questions from journalists on Thursday regarding his work in Kenya and in Africa. He further explained how the grant will be utilised and gave his thoughts on Kenya's decision to allow genetically modified foods. Here are the excerpts.

Which countries will benefit from the $7 billion funding you have announced?

Ever since the foundation started back in 2000, Africa is the region we've been most involved in. We do a lot in Asia as well – in Iraq and Pakistan, India, Afghanistan, Indonesia – but not as much.

Given our commitment that children born everywhere don't have a much higher chance of dying just because their countries are poor, that takes us to developing countries, particularly low-income, low middle-income countries.

A lot of money that the foundation spends isn't geographic. So our work on an HIV vaccine will benefit all countries, same as our work on diarrheal vaccines, pneumonia vaccines and drugs for malaria. Malaria is mostly in Africa.

But the $7 billion (Sh855 billion) will mostly go to delivering programmes, buying vaccines for Africa, and paying for research and development to have better seeds in Africa.

Obviously, we do a lot in Kenya. Partners like AGRA (Alliance for a Green Revolution in Africa), AATF (African Agricultural Technology Foundation) are based here. Others are some international partners like International Livestock Research Institute, and CIMMYT (International Maize and Wheat Improvement Centre), which although it's headquartered in Mexico, the person who runs it is in Kenya.

Is all of the $7 billion new funding or has any of it been announced previously?  

We don't announce most of our spending. You know, like all our work on malaria, TB, there's really no forum where you can go and say, you're working on those things. I made an overall announcement about three months ago. If you don't count our [Covid] pandemic spending, which was a bit over $2 billion, we were at a spend rate of about $6 billion. But over the next four to five years, we would get up to a spending rate of $9 billion. And certainly, the $7 billion (Sh855 billion) over the four years is part of that overall spending envelope. And it'll be about 40 per cent more than in the previous four-year period. 

In 2016, you said the foundation was planning to spend about $5 billion on its operations across Africa over the next couple of years. What interesting lessons came out of that and were there any interesting failures?

You know, when you're trying to improve healthcare systems, you never give up. Because you want every child to have access to the vaccines, and every mother to have good antenatal care. There are certainly inconsistencies in Africa that don't achieve high vaccination rates. Some countries in sub-Saharan Africa and achieve 90 per cent vaccination rates, and there are some parts of the continent that only achieve 20 per cent vaccination rates.

That explains a lot about whether the primary health care system is operating well. A good primary healthcare system is not just about doctors, it's about community workers who show up, and it's about running the supply chain.

 It's about putting the facilities in the right place and educating people.

Other than the US government, we're the biggest funder of things related to HIV. And if you looked at HIV treatment, we have the 90-90-90 goal. I remember that was largely unachievable, but several countries, including Kenya, achieved 90-90-90. South Africa did not get there, but it got closer than I expected it would.

I'll give you an example of one thing that didn't work.

We funded trials to prove that if you take a drug called Tenofovir on a daily basis, that protects you from getting HIV. We were hoping everybody who's at risk of being infected would seek out Tenofovir and take it. And if you had 100 per cent compliance, then you would have ended the epidemic, you would have no one infected. 

But the uptake was quite low, less than 20 per cent. Now, we were learning from that, for the next-generation product that will be out in the next year or so. This offers 60-day protection. We're also working on another which offers six-month protection.

We do hope there'll be a high uptake of that, and that would stop HIV infections. 

You visited the Kenya Medical Research Institute (Kemri). What's your view on our preparedness for future pandemics, including Ebola.

Ebola is a terrible disease. And we're lucky that, unlike Covid, you're almost never infectious until you're very sick. So most of all infections take place when you're bedridden, which tragically means people who take care of you are the most likely to get infected – your family that's helping you out and medical workers. Tragically, you're actually more infectious after death than you are at any time. And so any practice that involves touching the body is potentially infectious.

So Ebola is never going to spread like Covid or flu. In the West Africa outbreak, more people died because the health system was shut down, so they died of malaria and other things than died directly from Ebola.

Likewise, Covid interrupted a lot of health services. The world at large is not as ready for the next pandemic, as I think it should be. Our foundation is very involved trying to get governments to make that a priority.

My last two books, one was on climate change (How to Avoid a Climate Disaster) and the most recent one was How to Prevent The Next Pandemic. And so in future we can do far better than we did in this pandemic. And, you know, we may not be as lucky, the crude fatality rate of this pandemic was actually quite low. And it was primarily the elderly.

Are there major lessons we learnt from the pandemic that you can share?

There were some things, like the investment that the Gates Foundation made in mRNA vaccines by funding Moderna and Biotech that did pay off, giving us quite a powerful tool. We had many other vaccines, and technologies, including the nanoparticle technology [which] also works very effectively. I think it did show people that we need to have better data systems.

The reason we're actually here at the University of Nairobi is they have a group that did the data modelling during the epidemic, and spoke publicly about the trends and what precautions people should take. 

I just announced as part of that meeting, a five-year grant of $5 million (Sh610 million) for this epidemic work here at the university to continue. 

Hopefully, they don't have to track a new pandemic. Hopefully, it's tracking malaria, diarrhoea, pneumonia,  first-30 days [newborn] challenges. So some health investments were accelerated because of the pandemic. 

What can we do to hasten green transition in this continent, given the climate crisis that's unfolding?

Well, the biggest area of work that we do is health-related, which has to do with, you know, reducing childhood death, reduce childhood malnutrition and helping mothers who are pregnant and dealing with big diseases like TB and HIV.

In the area of agriculture, the good news is that there's a lot of innovation, you can make much better seeds. Good example is a group [in Kenya] we fund called Water Efficient Maize for Africa (Wema). That was a very successful project where under drought conditions, maize productivity is about 30 per cent higher. And so that's extremely beneficial for farmers.

We also can bring into seeds disease- resistance traits.  I've seen Maize lethal necrosis, Fall armyworm, have been very troubling for farmers. There's a variety of ways to make seeds, all of which we fund, to get rid of those diseases.

Maize productivity in Kenya is actually not very high. If you look at Ethiopia, for maize, it would be over double the current [Kenyan] productivity. So by helping farmers get good advice on when to plant, helping them get access to credit, helping them do various types of water storage, there is the opportunity for Kenya to raise its productivity.

In some places, as the weather changes, you have to switch crops to something like sorghum, which happens to withstand heat, far better than maize does. So there's every reason to think that by adopting the right innovations, Kenya should go from being a net food importer of key crops to being largely self-sufficient.

The Kenyan government recently lifted a ban on GMOs and it has become a health concern in the country. Many biosafety groups ask why we would invest in genetically modified crops when the world is moving more to organic.

The world is not moving to organic foods. Ninety-nine per cent of all crops in the West are GM crops. The West is totally GMO, because that's the most productive. That's what has disease resistance.

Organic food is a small part of the market that's very expensive. Every piece of bread I've eaten is high-productivity wheat, GMO wheat. Every piece of corn I've ever eaten is GMO corn. And these are proven products. Nobody's trying to take something that hundreds of millions of people haven't already been eating with a perfect safety record.

How do you intend on working with rural Kenyan farmers to incorporate innovation and technology, and get them out of poverty and hunger?

Agriculture is our second biggest area of investment after health. Health is by far the biggest because there are many, many diseases.

In agriculture, we have had substantial success. For example, the farmer I met, Mary, was buying old chicks one day. And actually, she was buying them from three different suppliers: two in Kenya, one in Tanzania. And these chicks have been bred so that they grow very rapidly, they lay lots of eggs, the eggs are much bigger than the average egg and the also the meat value of these chickens is much higher. That's a programme we started about six years ago.

So it's amazing that now, hundreds of millions of those chickens have been delivered in Africa. And it's continuing to scale up in a pretty dramatic way. When you get that extra productivity, not only are you making more money from the market, but hopefully, you keep some of those eggs for your children, because eggs are incredibly nutritious.

Mary also had a cow that has been bred to retain the African characteristics of dealing with heat and disease, and to be far more productive in milk. So she's getting twice as much milk out of that cow.

What are your areas of interest in gender equality?

The foundation is very supportive of gender equality. Obviously, we have a gigantic emphasis on mothers; understanding the health of mothers. In maternal mortality, death of women has been brought down even more than the death of men, because previously there wasn't this attention on safe birthing practices to avoid bleeding, to avoid high blood pressure. So a variety of things have happened that are entirely focused on women and particularly their health, around pregnancy.

As you improve diets in a country, generally women are the ones who benefit the most. This iron deficiency, anaemia, is not just a problem for giving birth. We need to understand how to solve anaemia. So we do a lot in the health area.

We also fund efforts to get women into the workforce. But a country has to decide what its strategy is and then we'll come in and support that.  We don't come in with an external view of something that's so culturally specific.