Billionaire philanthropist Bill Gates has warned that global health inequalities remains stark, with children born in parts of Africa still 50 times more likely to die before age five than those in wealthier countries.

Mr Gates, chair Gates Foundation, made the remarks on Monday during a speech at the African Union headquarters in Addis Ababa, where he reflected on 25 years of the Bill and Melinda Gates Foundation’s work on the continent.

He said despite decades of progress, most child deaths under five still occur in low-income countries.

Mr Gates described this as “profoundly unjust”, noting that the fight to save young lives remains far from over.

While he highlighted the challenges, he also acknowledged the progress Africa has made in reducing child deaths, “thanks to decades of partnership, innovation, and investment in primary health care.”

“Looking back on these last 25 years, we have seen incredible progress. The reduction in under-five deaths from just under 10 million to now well under five million is really mind-blowing,” Mr Gates said.

He said this is more than twice as fast a reduction than in any period in history.

Mr Gates attributed this improvement to increased vaccine access, strengthened health systems, and political will across many African countries.

Fight against infectious diseases

Mr Gates further emphasised the foundation’s work in fighting HIV, malaria, tuberculosis, and polio, diseases that disproportionately affect African children and families.

“The deaths from HIV peaked soon after the turn of the century, and have now fallen from the peak by 70 per cent again, it was achieved through a partnership in the early years of the foundation,” Mr Gates said, citing the role of the Global Fund.

He praised Zimbabwe for achieving some of the best rates globally in HIV treatment coverage and viral suppression.

Mr Gates admitted that malaria remains a tougher battle, with mosquitoes and parasites evolving resistance to treatments.

“I believe there’s a real possibility over the next 20 years to completely eradicate malaria, and that would be a huge achievement,” he said, adding that much of the progress has been powered by innovations tailored for African realities.

He said the Foundation supported the development of a $2 rotavirus vaccine that once cost $30. In malaria prevention, he noted that the introduction of $5 dual-insecticide bed nets and smart data tools has made it easier to respond quickly to outbreaks.

He also highlighted the near eradication of polio in Nigeria.

“This effort started in 1988, well before there was a Gates Foundation. It was in 1996 that President Mandela and the organisation that would become the AU launched the kick polio out of Africa campaign,” he noted.

Tackling Malnutrition

Beyond infectious diseases, Mr Gates raised concern about the burden of malnutrition.

He said even children who survive may suffer long-term damage from poor nutrition.

He also noted that 40 per cent of children in sub-Saharan Africa face major health deficits that impact their development and productivity.

“Fixing a child’s nutrition at age five or six is too late,” Mr Gates warned. “We must focus on mothers’ health and the child’s first 1,000 days.”

He emphasised that malnutrition may be an even greater challenge than malaria or HIV, calling for more investment in nutrition solutions and early intervention.

Health as a foundation

Paulin Basinga, the Gates Foundation’s Africa director, in his comments, described Mr Gates’ message as a call to action for African governments and partners to prioritise health in national development plans.

Mr Basinga said an investment in health and education unlocks a demographic dividend that fuels growth and innovation.

In her remarks, the Deputy Chairperson of the African Union Commission, Selma Haddadi, reaffirmed the AU’s commitment to Agenda 2063, stressing the urgent need to strengthen food sovereignty, climate resilience, and health systems across the continent.

Ms Haddadi highlighted the importance of youth empowerment through education and innovation and underscored the critical role of women in Africa’s development journey.