Bill Gates, philanthropist and chair of the Bill and Melinda Gates Foundation, BMGF, was in Nigeria recently. After a private meeting with President Bola Tinubu, he met with youths in a forum themed ‘Advancing Africa: Unleashing the Power of Youth in Science and Innovation.’ After that Gates fielded questions from reporters.
Globally, the issue of climate change is in the front burner. What policies do you think can help out. Also, do you think investment and execution in health and education require significant attention in Nigeria?
We certainly have a strong message: cultural innovation is the only way to minimise the climate impact. It seems that even in the face of climate challenges, we need to be more creative. However, the overall funding situation is currently very tricky. The big donors, including Europe and the US, are spending massive amounts of money on things related to the Ukrainian war, such as civilian aid, military aid, and building resources for refugees.
In the latest OECD report, which is the best tracking developmental systems, it was found that about seven per cent (if you exclude some specific COVID-19 funding) is down slightly more. From a financial standpoint, considering interest levels and debt levels, it will be challenging to allocate resources. Nevertheless, we must focus on applying our finite resources to high-impact areas.
For example, even if funding for malaria doesn’t increase, we can still reduce its prevalence through innovation in malaria tools. Although it would be great to see funding go up, domestically we need to see how the government reallocates resources from one area to another, taking into account headwinds such as interest costs. However, this situation also presents an opportunity to prioritize health and education.
In Africa, particularly in parts of Nigeria, investment and execution in health and education require significant attention. We expect progress to continue despite setbacks caused by the pandemic. Measles campaigns were interrupted, and some health services were also affected. However, we believe we can resume these efforts and make further strides. Collaboration with the government will be crucial, and we plan to implement more programs and closely monitor the work being done and the locations where it takes place. Vaccine coverage levels are one of the key indicators we are monitoring closely, and we have multiple partners who share our dedication to vaccines.
The timing of my visit is partly due to the pandemic situation easing, allowing for travel. It is also an opportunity to meet the new president and provide input on the opportunities I see.
This question follows up on your previous response in 2019 when you discussed Nigeria’s low tax-to-GDP ratio, which was approximately six per cent at that time. Since then, it has increased to around 10 per cent. You mentioned that this low ratio contributed to a lack of investment in healthcare. Despite this increase, there hasn’t been a proportional rise in healthcare investment. According to your latest report, healthcare expenditure is just $10 per person. What recommendation do you have regarding the ideal amount per person, such as $20 or $30, and what proportion of the total budget should be allocated to healthcare? Do you have a specific recommendation in mind?
To ensure effective utilisation of funds, it is important to establish a basic level of funding, around $30 per person, and ensure proper allocation based on actual work performed. This includes aligning payroll with employees and tracking locations and supply chains. This approach has proven successful in countries like Nigeria, where 90 per cent vaccine coverage has led to a significantly lower death rate compared to the northern regions.
The comparison between sub-Saharan countries is quite significant because some of them have well-run primary health systems. Even economically disadvantaged countries like Niger have better vaccination coverage than certain Nigerian states in that area. Therefore, both financial allocation and execution are crucial factors in achieving successful healthcare outcomes.
During our meetings with governors, we have observed positive reforms in places like Kaduna. While some states may spend more on health due to increased healthcare expenditure, it is important to track data and implement effective personnel policies at the local government area (LGA) level. Through reforms, states have been able to monitor healthcare centers, ensuring that the right people are present and vaccines are delivered on time. This level of scrutiny provides valuable and timely data on the functioning of the healthcare system.
Ultimately, the goal is to establish a highly functional healthcare system, which would require moving towards the $30 per person funding target. For comparison, the United States spends $8,000 per person on healthcare, and the spending in Lagos is likely higher than $30. The impact of such investments can be seen in indicators like maternal survival and long-term outcomes such as nutrition. Therefore, it is crucial for domestic stakeholders to support the ongoing plan, as it directly affects the well-being of Nigerian children and the effectiveness of the primary healthcare system.
In addressing the topic of financial inclusion, the level of poverty in the northern region of Nigeria is extremely concerning. We have witnessed the positive impact of financial inclusion in alleviating poverty in other areas. Therefore, I would like to inquire about the strategies that your foundation, as well as the government, should undertake to expedite widespread financial inclusion, particularly in the northern region of the country?
Our financial services work, which receives an annual budget of approximately 150 million dollars, may not be as substantial as our health or agriculture programs, which are our largest initiatives. However, it has been highly successful in partnering countries such as India, Kenya, and several African nations to ensure widespread availability of digital money.
In Nigeria, we have already laid some foundational elements, including a digital ID system. The key to making this system effective lies in establishing seamless conversion between digital money and cash, commonly known as “cash in” and “cash out.” When individuals can easily move between digital and cash transactions within their communities, they begin to perceive digital money as flexible as traditional paper currency.
When someone sends money from Kano to a relative in Lagos via mobile phone, the recipient should have the choice to either withdraw the funds or directly use them at a store. To achieve this, Nigeria needs to focus on expanding network coverage, ensuring user-friendliness, and establishing a widespread cash-in and cash-out system.
These steps are crucial for Nigeria to match the levels of digital financial inclusion seen in countries like India or Kenya. While this program alone may not solve all the challenges, it holds significant importance, particularly for women who have their own savings and can utilize them for essential needs like food or family health expenses.
Consequently, this program plays a vital role, and Nigeria is on the verge of advancing it. We are actively collaborating with the government and providing assistance wherever possible. Additionally, we have established partnerships with numerous experts in this field to support the endeavor.
On innovation and vaccine production, it is widely acknowledged that innovation can be costly, as exemplified by the significant expenses associated with developing the COVID-19 vaccine. Considering the financial limitations, what strategies do you believe can be employed by Nigerians and young innovators to inspire and support them in testing their ideas and creating products for the global market?
The development of vaccines is not limited to small companies due to the regulatory requirements involved. Vaccines are global products, and it is not economically feasible to create a vaccine exclusively for one country. The production of vaccines is a complex process, often costing around 400 million naira if everything goes well.
In Africa, we have established capabilities for vaccine production. For instance, we have a group in Africa that specialises in yellow fever vaccines, and we are considering establishing polio vaccine production there as well. Therefore, Nigeria’s involvement in the global ecosystem of vaccine production is more about being part of a collective effort rather than individual entrepreneurs spearheading it.
While many inventions and creations can originate from Nigeria, they are likely to have a global impact. For instance, we invest billions in developing vaccines for diseases like Malaria or HIV, and a significant portion of those funds are allocated for trials conducted in Africa. These trials involve collaboration with skilled investigators and researchers on the continent.
Recently, we conducted a trial called the TB trial, and it was inspiring to witness the positive impact it had on students and the development of their skills. I am confident that we will continue to engage with the university and the exceptional team behind this trial to conduct more trials in the future.
In the field of medicine, I highly encourage young individuals who are fascinated by it to pursue careers as doctors or researchers.
There are ample opportunities to contribute to the advancement of healthcare and make a meaningful difference in people’s lives.
Regarding your involvement in various fields, including health, environment, and science, how do you effectively prioritise each area to ensure that none of these processes suffer? Additionally, how do you ensure proper allocation of funds, ensuring that they reach the intended recipients, specifically Nigerians?
My work time is divided into three main categories. Firstly, I spend some time at Microsoft, where I assist with the latest digital technologies, including AI. The CEO of Microsoft engages with me, which makes this aspect of my work enjoyable. While this is the smallest portion of my time, it complements my other responsibilities.
By far, the largest part of my work involves being the co-chair of the Gates Foundation alongside Melinda. We travel, work on partnerships, conduct strategy reviews, and ensure that our teams are functioning effectively. This role accounts for approximately 70-80 per cent of my time.
The final area of my work focuses on breakthrough technology related to climate mitigation. I have built a team dedicated to this endeavor, which operates like a new company. This aspect of my work has also been successful.
The main reason we are able to undertake these endeavors is because we have ample resources that enable us to hire exceptional teams. We have incredible teams dedicated to malaria, tuberculosis (TB), and policy. Our policy team collaborates with various governments, and we have offices in Nigeria, Ethiopia, South Africa, Kenya, and Senegal. Most of our projects involve engaging with people and overseeing significant initiatives, much like how I built Microsoft. I am currently focused on malaria and the progress of the TB team. I continually work on selecting the right goals and assembling the right people for these projects.
In terms of impact, we are fortunate that the vaccines we procure are delivered to the country without diversion to black markets. We have systems in place to track the delivery of vaccines, ensuring that workers and equipment are where they should be. There is a large team involved in this process, and the government plays a crucial role in ensuring its success. We have provided data systems to the government to facilitate this. Although most of the funding reaches its intended recipients, not all of it does. The health sector is complex due to the numerous diseases and the need to ensure survival rates. For instance, if there is a measles outbreak, it indicates that vaccinations were not administered effectively.
The most significant achievement we have had in Nigeria is eradicating polio. However, it has resurfaced in some form, necessitating renewed efforts to eliminate it once again. During the pandemic, the number of cases increased, but now they are declining, giving us hope. I will be speaking with governors and the president tomorrow to emphasize the importance of leaving the pandemic behind and focusing on other health challenges, such as malaria and measles. Seeing the positive outcomes, such as children surviving measles, reassures us that our resources are well spent.
I would like to express my appreciation for your efforts in Africa, as well as your belief in the potential of young Africans. I would like to inquire about your perspective on the actions that young people in Africa can take to overcome structural barriers and foster innovative solutions to address the continent’s challenges.
We understand the challenges faced in Nigeria, and even within the country, there are varying situations. It would be beneficial for people in Lagos and other regions to explore the country and identify opportunities for improvement. One of the key factors for African youth is ensuring they receive the necessary health and nutrition support. Additionally, providing educational opportunities is crucial. Both formal and informal education avenues, combined with internet access, allow for incredible learning possibilities.
It’s remarkable to witness individuals who have pursued online courses and gained expertise in specific fields, even without a college degree. For instance, the person responsible for managing the data in this trial achieved proficiency in using clinical data software through online learning. This exemplifies the power of motivation and learning when one is energized by a particular subject. Thankfully, accessing training and educational resources is easier today than ever before. Individuals can identify their strengths and passions and choose careers accordingly. Not everyone needs to be an entrepreneur; there are numerous ways to contribute and improve, such as becoming a doctor, teacher, or working for a large company.
There is widespread concern among many individuals regarding the potential of AI to replace job opportunities. Should we embrace AI as a welcome innovation, or should we be apprehensive about its impact, particularly in the field of healthcare?
We are mostly excited about the potential of accelerating drug discovery for infectious diseases, as well as other conditions like cancer and Alzheimer’s, among many others. It’s a remarkable advancement for humanity, and even at this early stage, we are starting to witness positive developments. However, like any technology, there is also the risk of its misuse by criminals for cyber-attacks involving AI. Therefore, it is crucial to ensure that defense mechanisms stay ahead of offensive tactics.
The potential of AI in providing capabilities such as efficient government services and personalized medical advice is immense. In the next five years, as the shortage of skilled workers decreases, we can expect significant improvements in accuracy and cost-effectiveness. Having a personal tutor that can adapt to your level and offer courses tailored to your needs is truly life-changing.
While I don’t disagree with addressing the challenges associated with AI, such as deep fakes, cyber-attacks, virus vulnerabilities, and biases in training, it’s important to recognize that these issues are often mistakes or flaws in the system. It’s great that these concerns are being highlighted, but it’s equally important for the public to understand the tremendous upside of this innovation. Perhaps there is currently an overemphasis on the downsides, but as AI becomes integrated into various software applications, people will begin to see firsthand how incredible its potential is.
*Excerpts of this general interview published by Thisday