Address at the Gavi Pledging Conference in Berlin, Germany

Bill Gates, co-founder Microsoft and co-chair Bill & Melinda Gates Foundation

Address at the Gavi Pledging Conference, Berlin, January 27, 2015


Thank you, Dagfinn. It’s a pleasure and an honor to be here today in Berlin.

I’d like to extend a special “thank you” to Chancellor Merkel, Minister Mueller, and the German government for hosting this event.

Chancellor Merkel, Minister Mueller, President Kikwete, President Keita, Prime Minister Solberg, excellencies, ministers, partners, distinguished guests.


Thinking about the significance of today’s replenishment conference, I was reflecting on the moment when the problem of global health inequity came clearly into view for Melinda and me.

We were reading a newspaper article about the major causes of child deaths worldwide. One of the most prolific killers was a disease called rotavirus, the leading cause of severe diarrhea in children.

I had never heard of rotavirus, and neither had Melinda. We were shocked to learn that almost all children get it, yet only children in poor countries were dying of it. We were heartened to learn that a promising vaccine was on the horizon – a vaccine that could save hundreds of thousands of children’s lives every year.

At the time, I was still running Microsoft, and we were starting a family. We had plans to do philanthropy later. But Melinda and I couldn’t stop thinking about the injustice of hundreds of thousands of children dying needlessly every year.

It didn’t seem like there was any time to waste. That’s when we decided to start our foundation and invest in a new organization called Gavi. Getting the rotavirus vaccine out to every child who needed it would be the first big test of our ability to help make a difference.

Today, the rotavirus mortality numbers are starting to come down. Since the Gavi pledging conference four years ago, more than 30 Gavi-supported countries have added the vaccine to their routine immunization schedule.

And with the commitments made here today, seven of every 10 children in Gavi-supported countries will receive the last dose of the rotavirus vaccine by 2020.

This is an incredible accomplishment. It is a testament to the generosity of donor governments, the vision of the founding partners – WHO, UNICEF, AND WORLD BANK – and the engagement of civil society and the private sector.

Most importantly, it is a tribute to the commitment and leadership of developing countries, which are squarely at the center of Gavi’s success and its future.


The theory behind the creation of Gavi was actually quite simple: align the efforts, resources, and expertise of governments, the private sector, multilateral organizations, and civil society – so everybody is pulling from the same end of the rope.

Yet, in its simplicity, Gavi’s business model was profoundly innovative. No one had ever done anything like it before.

By pooling the financial resources of donors – and the demand for vaccines among dozens of the world’s poorest countries – Gavi increased the capacity and competitiveness of manufacturers willing to produce vaccines for the developing world. That has spurred manufacturers to offer vaccines at unprecedented prices.

The role of developing countries in Gavi’s business model was also revolutionary: empowering governments to take the lead in building their own sustainable immunization systems – with ambitious but achievable co-financing and graduation mechanisms.


Over the last 15 years, we have learned a lot about what it takes to produce and introduce new vaccines. We’ve also learned a lot about the challenges of reaching all children.

Increasing coverage and vaccine equity will require us to double down on what we know works AND harness innovation to overcome obstacles that have capped our success for years. The good news is that we have a strong base to build on.

Backed by a strong political commitment and country investments, countries like Bangladesh, Rwanda, and Tanzania are leading the way in building sustainable immunization systems. Their experience has much to teach us.

Ghana has embraced rigorous measurement standards and the use of accurate data to inform decision-making at every level.

I visited there in 2013 and saw health workers poring over reports to identify which communities needed intensified efforts, and which ones were succeeding. Their commitment to a candid accounting of progress – good or bad – and linking data to decision-making is vital not only to the success of immunization programs, but to the improvement of primary-health systems generally.

In India and other developing countries, state-of-the-art manufacturing facilities are increasing our capacity to produce vaccines.

In Nigeria and other countries, solar-powered refrigerators are making it easier to store vaccines safely so we can reach more children.

Technology on its own won’t improve vaccine equity or coverage. But it’s exciting to see how health workers think differently and take the initiative when provided with new and better tools.

I saw a vivid example of this last year when I visited Ethiopia. One of the challenges with increasing immunization coverage is the need to keep vaccines consistently cool all the time. If vaccines get too hot or become frozen, their potency can be undermined. This is a particularly big problem if you’re in a hot climate without reliable electricity. In the past, there were few options to keep vaccines at the right temperature for long periods.

But that’s beginning to change. At a remote health post in Ethiopia, I met Birke Fisaha [Burr-ke Fee-saha], a health extension worker who has been testing a “super thermos” cooler that keeps vaccines at a safe and constant temperature for a month or more – without electricity or any moving parts that can jam or break.

Before the super thermos, Birke could only administer vaccines on certain days when she could pick them up at a center with refrigerated storage. Now, Birke can administer vaccines to kids any time – whether she is at the health post or on one of her visits to families in remote areas.

Birke was so passionate about her ability to reach more kids with vaccines that when a visitor on a previous trip suggested the pilot project might be ending, she picked up a stick and threatened to whack him if he tried to take the cooler. When I visited with her, we teased her about this. The “chop-chop” gesture she made with her hands made her position quite clear.

In another part of Ethiopia, we heard that health workers had started hitching this super thermos to camels, and doing multi-day journeys to reach communities that had never before been reached with vaccines.

The technology behind this new cooler is exciting. But the real value of this innovation is its ability to help health workers like Birke vaccinate reach more kids in places where no one has provided immunizations before or services are so infrequent that kids are being missed.

The next five years are about taking the best practices and pilot programs that have worked well and spreading them broadly. This will have a dramatic impact on raising vaccine coverage and ensuring equal access to vaccines.


A week ago, Melinda and I published our annual letter. We talked about the big bet we made when we started our foundation 15 years ago. The bet was that by backing innovative work in global health, we could help dramatically reduce inequity.

When we look at the progress the world has made in a generation, we’re optimistic that global health equity is an achievable goal. The best indicator of that is that the percentage of children who die before the age of 5 has been cut in half. Vaccines have been a critical part of that success.

Encouraged by this progress, we’ve picked an even more ambitious goal for the next 15 years. Our big bet is that the lives of people in poor countries will improve faster in the next 15 years than at any other time in history. And their lives will improve more than anyone else’s.

Vaccines are at the center of this bet, because immunizing the world’s children is necessary to achieve a world without extreme poverty, a world where mothers and children don’t die any longer from preventable causes or diseases, and a world where children have a chance not just to survive, but to thrive.

By contributing to this virtuous cycle, Gavi has done something truly remarkable. It has enabled us to break the vicious cycle of of disease, illness, and death that has burdened poor communities and families for so long.

Today, we have an alliance that can accelerate vaccine introduction and access on a timescale never before imagined.

With continued efforts, we expect the kinds of declines in cervical cancer, measles, and other diseases that we’ve seen with the introduction of the pneumococcal vaccine.

As new vaccines become available – for malaria, HIV, and Ebola –
Gavi can help ensure that they are procured and deployed quickly, safely, and efficiently.

By pairing the Global Polio Eradication Initiative’s funding for polio vaccines with Gavi’s expertise in introducing vaccines, we are moving closer than ever to the eradication of this disease.

And today, Gavi is working with Ebola-affected countries to help rebuild systems critical to delivering vaccines and other interventions. Without this kind of immediate support, outbreaks of vaccine-preventable diseases like measles could take more lives than the Ebola outbreak itself.


Realizing our shared vision of the future – of a better world – will not be easy.

It will require a political commitment at all levels of government, predictable financing, an effective cadre of health workers, adequate vaccine supply, and strong community engagement.

But the payoff is worth it. The investments we are making today in Gavi will save almost as many lives in the next five years as we have saved in the last 15 years.

This is a mission that Melinda and I believe in deeply. And it is a mission that inspires us.

We are pleased to announce our 2016-2020 commitment of $1.55 billion, bringing our total commitment to Gavi since 2000 to more than $4 billion – money well spent to create the world we want for all of our children. Thank you.

Photo credit: Bill & Melinda Gates Foundation

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