Improvements in global health outcomes over the last two decades stalled during the COVID-19 pandemic, highlighting the need for increased innovation to catch back up.

Microsoft Co-Founder Bill Gates, now co-chair of the Bill & Melinda Gates Foundation, spotlighted the role gene sequencing and DNA-based pathogen surveillance can play in recovering from COVID-19 and blocking the next pandemic.

“We kind of have a duality here,” said Gates, who spoke Friday at Illumina’s Genomics Forum in San Diego. “The current health circumstances post-pandemic are not what we want them to be. It has been a gigantic setback.

“On the other hand, we have this innovation, much of it underpinned by genomics,” he continued. “So, on balance, I am very excited in how we can take that and use it for dramatic improvements in human health all over the world.”

Founded 22 years ago, the Gates Foundation focuses on health issues, particularly in developing countries, where infectious diseases can account for four in five deaths. Its work includes fighting malaria, malnutrition and infectious pathogens.

“We are using genomics to take a disease like malaria and track it, and eventually be able to achieve malaria eradication,” he said. “We are using genomics to solve malnutrition” through sequencing microbiome bacteria to better understand stomach health, as well as in agriculture to develop strong seeds for temperature, crop yield and disease resistance.

Global health initiatives since 2000 have helped cut the number of global deaths for children under 5 years old from 10 million to 5 million, Gates said. The United Nation’s Sustainable Development goal calls for reducing childhood deaths to 2.5 million by 2030.

In addition, polio is on the cusp of joining smallpox in being eradicated, said Gates. Malaria deaths, HIV deaths and tuberculosis deaths have fallen dramatically.

“Despite that progress, ever since the pandemic, we have either stalled or gone into reverse,” Gates said. “If you take the UN’s Sustainable Development goals set in 2015, with the aim of achieving them by 2030, we’re not in good shape.”

The Gates Foundation, whose donors include Berkshire Hathaway’s Warren Buffett and others, has pledged to increase annual spending on global health from $6 billion to $9 billion.

Gates has called for increased investment in the surveillance of infectious diseases, including monitoring wastewater for genetic markers of pathogens.

“We don’t want another pandemic,” he said. “It’s 20 million lives, $20 trillion dollars, huge deficits, learning loss, mental stress. We are going to be digging our way out of this for a long time.”

During the pandemic, the Gates Foundation partnered with Illumina, Centers for Disease Control Africa and others to set up surveillance programs in Africa, sequencing DNA of the coronavirus there to better understand variants.

“We have to accelerate innovation,” he said. “The only way we are going to get back on track is a combination of better tools, where genomic plays a big role, and better targeting, where surveillance enabled by genomics plays a big role.”