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Growing pains (Baz Ratner)

In Europe, a host of politicians look south across the Mediterranean and see a threat. Italy’s new populist government insists on turning leaky boats full of sub-Saharan migrants away from its shores. France’s president envisions funding migrant camps along the North African coast to keep the influx of arrivals at bay. And right-wing nationalists everywhere view these asylum-seekers as a menace rather than people in desperate need.

But the deprivation, violence and insecurity that many of these migrants are fleeing may only get worse. A new report from the Bill and Melinda Gates Foundation warns that rapid population growth in the world’s poorest countries may slow — or even reverse — the international community’s fitful efforts to combat global poverty.

“We want people to understand that that progress is not inevitable,” said Melinda Gates in an interview with Today’s WorldView.

“To put it bluntly, decades of stunning progress in the fight against poverty and disease may be on the verge of stalling,” she and her husband wrote in a preface to the report, which was released on Tuesday. “This is because the poorest parts of the world are growing faster than everywhere else; more babies are being born in the places where it’s hardest to lead a healthy and productive life. If current trends continue, the number of poor people in the world will stop falling—and could even start to rise.”

The report argues that more investments in health and education are needed in the developing world to make sure that surging populations turn into a demographic blessing rather than a curse. The problems are particularly acute in Africa: The report notes that by 2050, 40 percent of the world’s poorest people will live in the Democratic Republic of Congo and Nigeria alone.

“There is a very large youth population across the continent of Africa. 60 percent of the population is less than 25 years of age compared to Europe where it’s 27 percent of the population," said Gates. “And it hangs in the balance." If the right investments aren’t made, she added, “you’re going to have a lot more poverty and you’re going to have a lot more migration and problems across the word because we know disease and violence can spread.”

The report tracks 18 data points linked to the U.N.’s Sustainable Development Goals, ranging from child and maternal mortality and incidences of malaria to sanitation and access to banking. This year’s edition focused in particular on four major challenges: family planning and access to contraceptives — a cause Gates said is dear to her heart — improving education in low-income countries, fighting HIV rates and boosting agricultural productivity.

A series of case studies in the report spotlights precedents for success. For example, though its gross domestic product is a sliver of that of many Western nations, Vietnam’s significant funding of education has enabled its high school students to outperform U.S. and European counterparts in international science and math tests. Zimbabwe was once one of the nations most ravaged by the HIV epidemic; in 1997, one out of four adults was believed to be infected. But since 2010, new HIV infections are down almost 50 percent and AIDS-related deaths are down by 45 percent, largely due to the efforts of government and civil society programs backed by international donors.

Gates said the world needs to uplift young people in its most benighted corners. “If we make the right investments for those young people — provide access to contraceptives, quality schooling — they will prosper, they will make society better," she said.

The Gates Foundation is a philanthropic behemoth, which has presided over huge investments in the spread of vaccines that have arguably saved tens of millions of lives. But Gates admits that its efforts “absolutely depend” on political leadership around the world.

One example is France, which is hosting a major “replenishment” conference of the Global Fund to Fight AIDS, Tuberculosis and Malaria next year. The conference could net huge financial commitments from major world powers and donors.

Even “in tough political times,” Gates said, many wealthy countries have maintained steady commitments to global health. But in the case of the United States, where the Trump administration is seeking to gut humanitarian aid and has rolled back funding for reproductive-rights projects abroad, Gates expressed dismay.

“It’s incredibly disappointing to see the U.S. leadership deteriorating and the view of the United States deteriorating because of some of the egregious things that have been said by this current administration,” she said, adding that she still had faith in lawmakers in Congress to support international aid projects.

The gloominess of the report belies the general positivity that fuels Gates and the work of her organization. In the introduction, she and her husband extol their “belief in the power of innovation to redefine what’s possible." But in speaking to Today’s WorldView, she warned that the prospects of a “reverse” and a “roll back” in combating poverty is all too real if governments are unable to address the needs of their booming populations.

Still, Gates looks to a rosier future. “Bill and I believe in data and we look at data. When you look at the data, life is actually improving for people around the world,” she said, citing significant dips in rates of child mortality as well as malnutrition and successful development initiatives in countries as disparate as Indonesia and Ethiopia.

“Yes, there’s a gloomy, dark narrative in our headlines,” she added, “and I’m not saying every place is great — believe me, it’s patchwork — but life in general is getting better.”

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