Reaching the Last Mile Forum 2023

Bill Gates
December 3, 2023
Dubai, United Arab Emirates
AS PREPARED

Hello. I’m honored to be here at COP28 and the Reaching the Last Mile Forum. I’m encouraged that we are talking about the ways climate change affects health—and sharing ideas of how to help people thrive in a warming world.

Let me first thank His Highness Sheikh Mohamed bin Zayed Al Nahyan and the people of the United Arab Emirates for hosting us—and for your partnership on global health over the years. 

I’m personally very grateful for your commitment to polio eradication and the Islamic Development Bank’s support to end polio in Pakistan. We are proud to stand beside you in this effort.

And your father, Sheikh Zayed, and President Jimmy Carter did so much together to strengthen the fight against NTDs. I want to thank the UAE and all the governments and partners who have made this a priority. 

To understand how far we’ve come, let’s go back fifty years, when the people of Niger made their first major attempt to fight onchocerciasis.

Though the disease is also called river blindness, it doesn’t just affect vision. It causes awful lesions that can get severely infected. At one point, half of all West Africans were at risk of contracting oncho.

Early on, researchers in Niger set out to collect black flies to identify the ones spreading oncho. People spread larvicide from canoes and helicopters. Some avoided oncho by simply abandoning their land, even if it was fertile and desirable in every other way.

In 1987, the story took a turn. Merck created a simple pill that prevents oncho, and donated enough to give to entire populations, over decades.

It took a lot of hard work from community health workers to reach even the most remote areas, and even more fly catching—but in 2023, Niger achieved a remarkable milestone, becoming the first African country to eliminate transmission of the disease.

The UAE played a pivotal role in this success, by launching the Reaching the Last Mile Fund, to eliminate oncho and another awful disease, lymphatic filariasis, or LF. 

Our foundation has been honored to support the fund since 2017, alongside CIFF, the Helmsley Charitable Trust, ELMA, The END Fund, and other partners.

Since the world came together in 2012 with the London Declaration to prioritize the end of NTDs, 50 countries have eliminated at least one NTD and 600 million fewer people require treatment for them.

Now it’s time to finish the job.

As terrible as these diseases are, they are also preventable. But if we don’t keep up the pressure, the burden will grow. 

That’s especially true as climate change brings more extreme weather—which helps the vectors that spread diseases thrive for longer periods and in more places. 

That said, with commitment and funding, we will eliminate the threat of NTDs and save millions of lives. Modeling shows that increasing the coverage of treatments even modestly can have a dramatic impact over the next decade. It’s one of the best buys in global health.

To that end, I’m pleased to announce that the Gates Foundation is matching the $100 million commitment made by His Highness to the Reaching the Last Mile Fund. That’s a fivefold increase over our previous commitment—and the clearest statement we can make about both the urgency and our optimism.

The fund will ultimately total $500 million, with the Carter Center and other donors joining in—including African countries. With their generosity, the Reaching the Last Mile Fund will be able to expand its reach from seven to 39 countries across Africa and in Yemen.

Our foundation has also renewed our commitment to partner with the government of Belgium to eliminate sleeping sickness in the DRC by 2030.

I’m confident we’ll be able to eliminate these diseases, for a few reasons.

First, because of the progress we’ve already seen, and the success of the RLM Fund so far. Thanks to the commitment of government, community, and traditional leaders, Niger has eliminated transmission of oncho, Senegal will do so soon, and three African countries are close to eliminating LF.

Second, I’m optimistic because of promising advances in surveillance and supply chain efficiency. 

Third, because of the generous commitment of pharmaceutical companies to producing and donating the drugs needed to prevent and treat these diseases. 

Now is the time to double down on these efforts. I’m confident that together, we can rid the world of these debilitating diseases. Thank you.