2020 ANNUAL LETTER

Gates funding once-a-year ARVs, says annual letter

"Every person deserves the chance to live a healthy and productive life"

In Summary

•The letter is titled “Why We Swing for the Fences: Reflecting on the First Two Decades of Our Foundation.”

•Melinda Gates makes a strong case for Gavi as the organisation fundraises for its next five years of work.

Bill and Melinda Gates during a visit to Gugulethu Community Health Clinic last year, in Cape Town, South Africa.
Bill and Melinda Gates during a visit to Gugulethu Community Health Clinic last year, in Cape Town, South Africa.
Image: COURTESY

The Bill and Melinda Gates have expressed their interest in the development of drugs that need to be taken only once a month or even once a year to prevent HIV, instead of every day. 

Bill and Melinda say even though there exist preventive pills that are 99 per cent effective when taken daily, such pills have not made a major dent against new HIV infections in developing countries.

They said they will now be focused on funding treatment options that are long-lasting. 

 

Such options would also include long-lasting ARVs for people already living with the virus.

"Imagine if, instead of having to take a pill every day, a person could get one injection every other month, an implant in his or her arm, or even a vaccine to entirely remove the risk of getting the virus," they say in their  2020 Annual Letter, released on Monday.

The letter is titled “Why We Swing for the Fences: Reflecting on the First Two Decades of Our Foundation.”

"But, just like with today’s preventatives, the medication has to be taken every day. We’re looking for new treatments that can be taken less frequently, as much as a year apart."
Bill Gates

The letter explains the progress made since the Global Fund to Fight Aids, Tuberculosis, and Malaria was founded in 2002, with the help of the foundation. 

"In 2018 alone, nearly 19 million people received life-saving HIV treatment in countries where the organization invests," Bill says in the letter.

He says with the Global Fund, the world has a pipeline to get new innovations out to the places that need them the most. 

By end of 2018, health programmes supported by the Global Fund partnership had saved 32 million lives.

 

The Gates Foundation is the biggest private contributor to Global Fund. 

In the 2020 letter, the Gates note that today, an HIV-positive person receiving treatment has the same expected lifespan as someone without HIV.

"But, just like with today’s preventatives, the medication has to be taken every day. We’re looking for new treatments that can be taken less frequently, as much as a year apart."

 Kenya has made significant progress in reducing the rates of HIV infection: new cases of HIV have declined dramatically since 1990, from 7.8 to 2.0 per 1,000 people.

However, 1.6 million Kenyans remain living with HIV, and in 2019, 25,000 Kenyans died of Aids-related illnesses.

While more people are accessing life-saving treatments, there are other factors that contribute to HIV infections. 

“We know, for example, that across southern and eastern Africa, adolescent girls and young women account for a disproportionate number of new HIV infections. Poverty, violence, and gender norms all play a role in why,” Melinda writes. 

In this year’s letter, Bill and Melinda reflect on how the risks they’ve taken in health and education have laid the foundations for future progress. 

In this year’s annual letter, Melinda and I write about the work our foundation has done on health and education over the last twenty years and why we think the risks we’ve taken have set us up for future progress. We also write about two issues that have emerged as priorities for us—climate change and gender equality—and how they will factor into our next 20 years. You can read the whole letter at https://gatesnot.es/3bk40oL

Altogether, the foundation has spent Sh5.4 trillion ($53.8 billion) over the last 20 years.

“At the core of our foundation’s work is the idea that every person deserves the chance to live a healthy and productive life,” the Gates write. “Twenty years later, despite how much things have changed, this is still our most important driving principle.” 

In 2000, the Foundation worked with the World Health Organization, the World Bank, and UNICEF to create Gavi, the Vaccine Alliance, which today funds most of the children vaccines in Kenya. 

"By 2019, Gavi had helped vaccinate more than 760 million children and prevent 13 million deaths (globally)," the letter says.

"It has also succeeded in bringing more vaccines and supplies into the market while lowering prices. For example, a single dose of the pentavalent vaccine, which protects against five deadly infections, used to cost $3.65. It now costs less than a dollar."

The pentavalent vaccine was introduced in Kenya in 2001.

We think going big on Gavi was one of the best decisions we’ve ever made—and we’re thrilled with the return we’ve seen on our investment"
Melinda Gates

Melinda notes globally today, 86 per cent of children around the world receive basic immunizations, the highest figure ever.

However, she notes that reaching the last 14 per cent is going to be much harder than reaching the first 86 per cent because the children in this group are some of the most marginalized children in the world.

"Picture, for example, the child of recent migrants living in overcrowded, impoverished areas of Nairobi or Rio de Janeiro," she notes.

She makes a strong case for Gavi as the organisation fundraises for its next five years of work.

"More funding will allow Gavi to save more lives. We think going big on Gavi was one of the best decisions we’ve ever made—and we’re thrilled with the return we’ve seen on our investment," she says.