Bill Gates’s year-end retrospective is kind of rambling but here are a few points I pulled out:

1. Lots more vaccines were administered to children in developing countries using new technologies and new delivery methods. This has made a big difference in child mortality, and that is always a happy thing. He doesn’t really go into details on the new technologies, but I am imagining things like nasal sprays rather than needles, and vaccines that don’t require refrigeration or not as much. And sometimes we just figure out how to make familiar things but make them much cheaper, and this can make a huge difference. Which would illustrate that important technologies don’t have to seem extremely complicated and high-tech to have a big impact.
2. On the AI front, he says it will accelerate drug development, including solutions for antibiotic resistance. I don’t doubt this, although I suspect the hype has gotten a bit ahead of the rollout. So I would look for this over the next half-decade or so rather than expecting it to burst on the scene in 2024. Bill actually predicts “18–24 months away from significant levels of AI use by the general population”.
3. He talks about AI tutors for students. I don’t want to be a Luddite, but I am concerned this will just mean less teachers per student, which will be bad.
4. Maybe AI can just get our medical records under control. This would be nice. Transparent, common protocols for how medical records should be formatted, stored, and shared could also do this though. I can someday hope robots will constantly clean up and organize my messy house as I just throw my things everywhere, or I could organize my house (which would take a big effort once) and keep it that way (which would take small, disciplined daily efforts).
5. Gut microbiome-based medicine. Sounds good, I guess. Then again, whenever we try to replace nutritious whole foods with highly manufactured alternatives (vitamin pills, baby formula) we tend to decide later that we should have stuck with the whole foods.
6. “a major shift toward overall acceptance of nuclear” power. Well, it’s been pretty obvious to me for a long time that this had to happen, but maybe the world is catching up. Nuclear could certainly have been the bridge fuel to renewables if we had fully adopted it decades ago. The question now is whether, given its incredibly long time frames to get up and running and the fact that any technology is obsolete by the time it is up and running, and the current pace of renewables, it still makes sense. I definitely think we should put some eggs in this basket though.
7. He mentions the fusion breakthrough at Lawrence Livermore about a year ago. It’s been a year and we haven’t heard much more – is the time to refine and rollout that technology going to be measured in years, decades, or never?
8. He talks about the need for more investment in electric grids and transmission lines. Yes, this is unsexy but really needs to happen. Will it?