When we outlined the 6 global health challenges we'll tackle in 2024 at the start of this year, we knew we were taking on complex problems. A year of testing solutions and honing delivery methods – from water treatment devices in India to prenatal supplements in Nigeria – taught us valuable lessons and sharpened our focus.
Taking stock of 2024, it was a year of breakthroughs and revelations – here are some highlights:
🤰🏽Shared new data on the rapid national scale-up of our Syphilis-Free Start program in Liberia, where 88% of syphilis-positive women are now being treated – and Zambia and Cameroon are poised to follow suit.
🚰Took you on a behind-the-scenes tour of our safe water initiatives in Africa featuring some of the people driving its recognized social impact, explained our unique monitoring and evaluation approaches, and recounted the story of the team who invented the open source device we now use for piped safe water delivery.
🚀Offered a glimpse into our Accelerator pipeline, where only the most promising, cost-effective interventions survive our rigorous testing in our pursuit of transformative global health solutions. Five new programs are currently in development.
Some initiatives exceeded expectations, others faced unexpected bumps, and most need further refinements to maximize their impact. Here's a candid look back at what we achieved this year, where we have room for improvement, and what we learned.
1. Safe drinking water in India: engineering bold solutions for the toughest delivery challenges
What we tackled:
Building on our safe water experience in Africa, our Safe Water Now program launched an ambitious water treatment pilot in India to expand chlorination access in rural communities. This partnership with India's Jal Javeen Mission has the potential to reach tens of millions of households and transform water safety across the country. Through extensive testing and refinement with our technical partner in India, EAII Advisors, we transformed early design challenges into engineering breakthroughs. Our iterative testing led to two innovations – a "T-design" chlorinator for low-flow systems and a "Z-design" that boosts coverage in previously unreachable high flow sites.
We strengthened our technology through strategic partnerships leveraging a leading Indian university's advanced testing facilities and an engineering hub in Nairobi. And 84 pilot installations provided real-world performance data across diverse conditions. Comprehensive evaluation – from tablet supply chains to monitoring methods – focused on identifying the most effective approaches for implementing in-line chlorination, positioning us to support state governments in bringing safe water to millions in the coming years.
What we didn't:
Our pilot revealed new challenges to solve in scaling water treatment across India’s varied infrastructure. In high-flow systems pumping over 30 m³/hour, corrosion occurs when chlorine meets metal components. While our solutions work well for most village systems, larger multi-village schemes present new complexities. Then there's the challenge of consistent dosing in systems with multiple input pipes – imagine trying to get the exact right dose of chlorine when water is flowing in from different directions at varying rates. These are some of the technical hurdles still ahead of us, but they also represent exciting opportunities. By addressing these challenges, we have the chance to pioneer innovative solutions that could unlock safe water access for communities currently beyond our reach, setting new benchmarks for scalable and sustainable water treatment systems.
2. HPV vaccine for cervical cancer prevention: why wait when we already know what works?
What we tackled:
This year, we set out to leverage our proven school-based delivery model to provide lifesaving cervical cancer prevention to girls in areas with low vaccine access. In Malawi, the human cost of cervical cancer is staggering: 7% of women will develop the disease, and their odds of dying are seven times higher than the global average. With just two oncologists for 20 million people and minimal screening access, less than 3% of women survive five years after diagnosis – compared to 91% survival in the U.S. By scaling HPV vaccination, we have the potential to prevent half of cases. Better yet, our recently launched school deworming and anemia programs in the country (more on that below), would stretch every dollar further. The estimates are compelling – we could prevent 10,000 cancer cases and 8,000 deaths over three years with this intervention, which is currently in Stage 5 of our Accelerator.
What we didn't:
Despite compelling evidence, securing sufficient funding remains a challenge. While introduction of HPV vaccination is generally well funded, ongoing support to implement high-quality, sustained vaccination after introduction is virtually nonexistent, resulting in dramatic declines after the initial introduction takes place. This disconnect between impact potential and funding availability remains our biggest obstacle to scaling this proven intervention. We believe in the game-changing potential of school-based HPV vaccination, so in 2025, breaking this cycle of short-term funding for long-term health will be high on our agenda.
3. Micronutrient supplementation for pregnant women: pushing boundaries to bring a proven solution where it’s needed most
What we tackled:
In September 2024, we launched our multiple micronutrient supplementation (MMS) pilot in Nigeria, our first step toward helping countries to leapfrog outdated prenatal nutrition standards and adopt the prenatal vitamins long available in high-income countries. These vitamins reduce low birthweight – a major driver of neonatal mortality, stillbirths, and poor fetal growth. While MMS remains largely unavailable at scale in most low-income countries, our Accelerator recognized the enormous potential to deliver this intervention cost-effectively through existing prenatal care systems.
The pilot takes aim at the challenge of ensuring pregnant women take the necessary amount of the six-month course of daily prenatal vitamins in order to see the health benefits. We’re evaluating how women receive and use prenatal supplements, what support tools work best for consistent use, and how clinics currently manage anemia testing capabilities. This builds on a detailed facility assessment and focus group discussions with healthcare workers and pregnant women in Nigeria.
The pilot is already yielding valuable insights. We're testing ways to strengthen both the technical elements – like anemia screening equipment – and the human aspects, from SMS text reminders to counseling tools that help women maintain their supplementation routines. Pilot learnings also helped us better tailor exploration in Liberia, Cameroon, and Tanzania as we look ahead to expanding our support for MMS in other high-need counties.
What we didn't:
Our initial work in Nigeria has shown us what’s needed to introduce MMS programs effectively on a larger scale. Anemia testing is essential for identifying women who need additional iron beyond standard prenatal supplements, yet only about half of pregnant women currently get tested – a crucial gap in the care pathway. While our pilot provides MMS to all pregnant women and extra iron for those with anemia, scaling this comprehensive approach requires reliable and cost-effective anemia testing equipment, better training and supervision, and solutions to make care more affordable. Strengthening these elements within existing health systems in Nigeria and beyond will be the focus of our next phase of work in maternal nutrition.
4. School-based health in Malawi: scaling healthier futures for entire generations
What we tackled:
Building on our track record, we designed and launched an integrated Deworm the World and Equal Vitamin Access school health program in Malawi this year. By supporting the government to combat parasitic worms and anemia — persistent health issues for children and adolescents — we are helping unlock the full potential of an entire generation of Malawians.
In Malawi schools outnumber health facilities seven to one and over half of children face worm infections and anemia, making schools a powerful platform. By combining program components, we can reach children efficiently for less than $0.50 per child per treatment per year to help them grow up healthier, stay in school, and improve their lifetime productivity. Over three years, we aim to reach 3.5 million children and prevent 900,000 cases of anemia, while generating approximately $130 million in economic benefits through deworming by 2046.
What we didn't:
We're still working through the complexities of running two interventions simultaneously in a new context. Our work has just begun: ensuring continued supply of iron and folic acid tablets for weekly supplementation, supporting community outreach strategies, and evaluating outcomes through ongoing monitoring and rigorous coverage surveys. Early implementation lessons are actively shaping improvements to our integrated model as we consider potential expansion to other countries.
5. Deworming: pioneering the next frontier of disease control
What we tackled:
After more than a decade of supporting governments to deliver over 2 billion deworming treatments, Deworm the World has achieved remarkable results– in some areas, worm infections have dropped 97%. These dramatic prevalence declines means we're entering a new phase, allowing for reductions – and sometimes even suspension – of mass treatment programs. Our role is evolving too – from helping governments implement large-scale treatments to designing smart surveillance systems that will protect these hard-won health gains for the long term. This year, we transitioned two Indian states to full government ownership and are planning similar transitions in six more Indian states by 2025, while continuing to support treatment for 180 million children across Kenya, Nigeria, Malawi, Pakistan, and other Indian states.
We’re planning strategic exits in areas where prevalence has fallen below the WHO threshold for suspension of treatment (2% for soil-transmitted helminths and 1% for schistosomiasis), while continuing the fight against worms in regions where they remain a problem. Our experiences have helped shape the WHO's new guidance on monitoring and evaluating worm prevalence changes, contributing to the still-evolving global standards for adapting deworming programs as disease control efforts succeed.
What we didn't:
Success introduces new questions: what happens when you reach WHO targets for eliminating these diseases as public health problems and reach very low levels of prevalence? It becomes increasingly expensive to measure impact in a changing disease environment – traditional surveys are less cost-effective when you're looking for fewer cases. While innovative approaches like model-based geostatistical methods show promise in efficiently measuring prevalence changes, significant methodological work is still ahead. We'll need to guide governments on transitioning from mass treatment programs to targeted, sustainable interventions and equip them with tools and strategies to maintain health improvements long after disease control targets are achieved.
6. The global climate-health agenda: connecting the dots for rigorous action
What we tackled:
As climate disasters intensify, their health impacts hit vulnerable communities first and hardest. Yet funding for climate-resilient health solutions remains scarce. Our water treatment interventions could play a crucial role in global strategies and national climate adaptation plans. We've made strides in highlighting the critical link between climate change and water safety, showcasing learnings from our response to Cyclone Freddy in Malawi at global convenings and highlighting the importance of adaptable, low-cost interventions in crisis situations.
What we didn't:
We're still working to make this connection clear to decision-makers and funders. While the technology works, and chlorine’s efficacy against diseases like cholera is well established, we need stronger data showing how it builds climate resilience at scale. We are working on gathering rigorous data to verify community accounts and continuing to monitor how our technology performs in extreme weather.
While our primary focus remains delivering safe water to communities that need it today, we're committed to assessing how our solutions can strengthen climate adaptation. Additionally, we are exploring how our nutrition interventions can factor into climate resilience. Better data and deeper collaboration with academics, global experts, and policy stakeholders will help us make a stronger case.
Tackling complexity, delivering impact
Both successes and challenges we've encountered this year reinforce a crucial lesson: taking evidence-based solutions "off the shelf" and converting them into real-world impact requires more than just proven interventions – it calls for technical excellence, deep understanding of local realities, and the monitoring to know whether they're truly delivering the intended outcomes. From vaccines to deworming pills to chlorine tablets, the interventions themselves are straightforward. The complexity – and our core work – lies in building the systems that deliver them reliably to millions.
As we look ahead to 2025, we'll continue strengthening the foundations that make research-backed interventions work in the real world. Driving every innovation and system improvement are mothers receiving better prenatal care, children growing up healthier and staying in school longer, and communities accessing safe water for the first time. By turning evidence into tangible benefits, we are transforming daily lives and health for generations. Because creating world-changing impact means getting the details right, even when they're complex.