Bill and Melinda Gates. (Photo: AP) Bill and Melinda Gates. (Photo: AP)

Bill Gates has made a New Year’s resolution. He is committed to learning and thinking about the balance between privacy and innovation, and about the use of technology in education.

These, he writes in a blog post, are two 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.”

Reviewing his own work and that of the Bill & Melinda Gates Foundation during the past year, Gates writes about achievements in health care, energy and medical research.

Gates saw two positive trends in Alzheimer’s research in 2018. He had contributed $100 million to startups and a venture capital fund focused on the disease the year before.

Researchers, he says, are focusing on two new hypotheses about why patients’ brain cells break down: (a) because their mitochondria, or energy producers, wear out; (b) because part of the immune system gets overactivated and attacks them.

In addition, the Alzheimer’s community is working to get and share more data, the better to understand questions such as how the disease progresses. One challenge ahead is to develop more efficient ways to recruit patients for clinical trials — at present, he notes, it can take several years to enroll enough patients in trials.

A big disappointment last year, Gates writes, was the uptick in polio cases when he had thought the disease’s eradication was close at hand. He puts this down to the difficulty of vaccinating children in areas where political violence and war are facts of life. “This is a key reason why Afghanistan and Pakistan have never been free of polio — in fact they are the only two countries that have never been free of polio.”

On the clean energy front, an investment fund in which Gates is involved is starting to put money in companies that are looking at all the drivers of climate change, and taking innovative clean-energy ideas out of the lab and putting them on the market.

During this coming year, and unrelated to his foundation work, he says he plans to speak out more about how the U.S. needs to regain its lead in nuclear power research. To do this, the country will have to commit new funding, update regulations and demonstrate to investors that it is serious.

One promising idea, he says, is an approach used by TerraPower, a company he started a decade ago. This is called a traveling wave reactor, which, he says, is safe, prevents proliferation and produces little waste. A hoped-for pilot project in China has become a nonstarter owing to recent U.S. policy changes, he says, but funding and regulatory changes could enable it to be built in this country.

The 100th anniversary of the Spanish flu epidemic that killed tens of millions of people around the globe did not generate much discussion on whether the world is ready for the next global epidemic, Gates writes. Being prepared requires a plan for national governments to work together, but not much progress occurred in 2018.

However, he sees good news in progress toward a vaccine that would protect people from every strain of flu — the form the next global epidemic is most likely to take. The Bill & Melinda Gates Foundation is providing funding to scientific efforts to develop a universal vaccine.

Gates agrees with criticism of the Chinese scientist who announced in November that he had altered the genes of two girls when they were embryos. But some good can come from that work, he says, if it prompts people to learn about and discuss gene editing. “This might be the most important public debate we haven’t been having widely enough.”

It deserves at least as much attention as artificial intelligence, which is being subjected to robust debate, he says. He recommends a book on the topic, “The Gene” by Siddhartha Mukherjee.

Gates notes that gene editing is raising hopes for treating and curing diseases — including some his foundation works on (“though we fund work on altering crops and insects, not humans”) — but could worsen inequity, especially if it is available only to rich people.