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Microsoft co-founder Bill Gates at his office in the Seattle area. (GeekWire File Photo / Kevin Lisota)

It’s almost hard to remember the Bill Gates of yesteryear — the brash, competitive, hard-charging business leader known to dismiss Microsoft managers by telling them they’d just presented the “stupidest” idea he’d ever heard.

Now, at the age of 63, Gates is contemplative, intellectual and thoughtful — an impatient optimist working hard to tackle some of the planet’s most pressing problems. It’s a fascinating transformation, and Gates’ writings are deep and analytical. It’s a stark contrast from the sound-bite and tweet-dominated world that drives so many conversations in this era.

In a newly published, 2,618-word essay — created in the “corny” tradition of his parents’ year-end letters to friends — Gates leads us on a journey of some of the top things on his mind.

“What connects it all is my belief that innovation can save lives and improve everyone’s well-being,” Gates writes. “A lot of people underestimate just how much innovation will make life better.”

The letter, titled “What I learned at work this year,” dives deep into five core areas — Alzheimer’s, polio, energy, the next epidemic, and gene editing — and four of those are directly tied to human health and well being. The focus on human health is no surprise, given the work of the Bill & Melinda Gates Foundation, but the letter shows how Gates’ perspective is evolving.

He writes that the world is shifting to a “broader understanding of well-being,” saying this will be “the thrust of many big breakthroughs of the future.”

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Here’s what else is on Gates’ mind as he reflects on 2018 and looks ahead to 2019:

What keeps him up at night: Gates doesn’t mince words when it comes to the threat of an epidemic: “We still are not ready.” He predicts that the next global health crisis will come in the form of a flu and says it could kill nearly 33 million people in six months if it’s as deadly as the Spanish flu epidemic that struck 100 years ago.

Gates is also frustrated by the slow fight to eliminate polio from the world. “I thought we would be closer to eradicating polio today than we are,” he writes. Polio was one of the first big philanthropic challenges that Gates took on, working alongside Rotary International and other organizations. In 1997, Gates traveled to India and administered oral polio vaccines to kids, and talked about the eradication of the disease. While he and other global health workers made early strides toward reducing outbreaks, there were 29 cases of Polio in 2018, up from 22 in 2017.

An environmental health officer tests sewage for the polio virus in Nigeria with Gates Foundation CEO Sue Desmond-Hellmann. (Gates Foundation Photo)

What gives him hope: Despite the challenges, Gates still believes a polio-free future is within reach. He’s optimistic about a new oral vaccine for polio being tested in Belgium and Panama. The treatment “would overcome some of the problems with previous oral vaccines when they’re used in places where few children are immunized,” Gates writes. The vaccine could be administered as early as 2020.

Gates says he still spends a lot of time on Polio, talking to funders about wiping out the disease. “I remind them of the huge benefits of success, and the risk that the disease will return in a big way if we don’t finish the job.” In 2017, Gates committed $300 million to the Polio eradication effort, following remarks he made in 2014 that wiping out Polio is easier than fixing the U.S. education system.

Gates is also encouraged by positive trends in Alzheimer’s research over the past year. In particular, he’s excited about increased funding, better data, and improved diagnostics for the confounding disease.

Melinda and Bill Gates at the University of Washington at a December 2017 ceremony celebrating the UW’s new Gates Center. (GeekWire Photo / Kevin Lisota)

What he’s planning in 2019: Next year, Gates plans to focus on technologies that hold great promise and great risks. In his words, these are “areas where technology has the potential to make an enormous impact on the quality of our lives, but also raises complex ethical and social considerations.”

Specifically, he’s looking at the balance between privacy and innovation, and the use of technology in education.

“How can we use data to gain insights into education (like which schools do the best job of teaching low-income students) or health (like which doctors provide the best care for a reasonable price) while protecting people’s privacy,” Gates asks. “How much can software improve students’ learning?”

Education has been a difficult area of focus for the Bill and Melinda Gates Foundation. The organization spent more than $200 million on a project aimed at improving kids’ performance by evaluating teachers based on student test scores. A new report published this year found that the initiative failed to meet its objectives, particularly in serving low-income students.

“For years we have been hearing overheated claims about the huge impact that technology would have on education,” Gates writes. “People have been right to be skeptical. But I think things are finally coming together in a way that will deliver on the promises.”

Nuclear energy and climate change: Addressing climate change, Gates writes that he will “speak out more about how the U.S. needs to regain its leading role in nuclear power research” in the year ahead. He notes that this initiative is separate from his work with the Gates Foundation.

“The world needs to be working on lots of solutions to stop climate change,” he writes. “Advanced nuclear is one, and I hope to persuade U.S. leaders to get into the game.”

How he measures success: At the end of the day, Gates’ thinking on success has changed, thanks in part to his wife, Melinda, and his bridge-playing pal, Warren Buffett, whose measure of success is, “Do the people you care about love you back?”

Gates calls that “about as good a metric as you will find.”

Read Bill Gates’ full year-end letter here.

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