STEVE INSKEEP, host:

Technology earned billions for Microsoft co-founder Bill Gates. Now, the Bill and Melinda Gates Foundation depends on technology to solve some of the world's biggest problems. That foundation has spent years working to improve global health, attacking diseases like AIDS or malaria. And the couple whose names are on the foundation visited the nation's capital this week. They are thanking taxpayers for their generosity.

Government aid for health overseas increased dramatically under President Bush and remains high today, even at a time of big deficits. Yesterday, we sat down with Bill and Melinda Gates in a Washington hotel, and we spoke of the way they target their money.

Mr. BILL GATES (Bill and Melinda Gates Foundation): You know, the U.S. government spends eight billion a year on global health - .25 percent of the U.S. budget. So, not a gigantic percentage, but it's over five times what we spend. And, you know, we tend to focus on a lot of the research-type things, new vaccines. The eight billion is very focused on delivering the things that work.

So we often work together, but only by having that large amount of resources, the government expertise and the U.S. government setting an example for other rich governments - that's the only way the global health endeavor has managed to be so successful.

INSKEEP: What's an example of how you think about where you want to direct your resources? I mean, if we just think about something like AIDS - there are a million medical and political opinions about what is appropriate or the best way to approach that.

Ms. MELINDA GATES (Bill and Melinda Gates Foundation): Well, I think one of the things you have to understand is, fundamentally, Bill and I believe in the advances of technology, and in this field it's biotechnology. If you didn't have a life-saving vaccination available, you don't change the face of a disease. So, ultimately, our long-term goal is to get a vaccine for AIDS.

So, we're always saying to ourselves, okay, which proposals have the best chance of getting an AIDS vaccine, and we work a lot with the scientific community on that. And then the discussion comes down to, okay, but given that we don't have a vaccine, what other pieces do we invest in today to make sure we prevent the disease as much as we can or even help treat people.

So, those are the conversations back and forth. It's much more how much money are we going to put into the research pieces, versus the pieces on the tools that actually do exist today.

INSKEEP: You talk about technology and preventing the disease. You've spent a number of years trying to develop something, a microbicide, that women can take themselves that serves the same function as a condom, say. Can you just talk through what directed you to that idea and what the results have been - good and bad?

Mr. GATES: Well, the microbicide trials have not been successful so far. There are some of those that we fund going on, the U.S. government funds a lot as well. We were hopeful for the early microbicide stuff, but...

INSKEEP: Didn't work out.

Mr. GATES: ...even when those trials failed, we, you know, we stuck with the area we still think something can work.

Ms. GATES: And I think that's a really important point to realize, is the role of a foundation is that we can take risks where a government won't or can't take the risks sometimes. So, we kept trying different microbicides, and as we learned from one, we'd try another.

INSKEEP: I was interested in this example, though, because it seems like it points to the possibilities of technology, as well as some of the challenges. The possibilities being that I guess a woman can make the decision herself, about protecting herself. And there are a lot fewer political or just physical barriers to that - if it works. And, of course, the challenge is finding something that actually works and that you can reliably deliver to a lot of poor people in a lot of poor places.

Ms. GATES: Absolutely. Because if a woman can protect herself, covertly, from her partner, that is incredibly important in the developing world. She can save herself and save the life of her child. And a lot of times, it's important even that the woman's husband doesn't know that she's doing this. Because he might be bringing AIDS home, which is often what happens, and then she inadvertently gives it to her child.

INSKEEP: But then there's the question of getting it to work. Do you wonder sometimes about the limits of technology in less-developed areas?

Ms. GATES: Well, there are limits, absolutely. But in this case of microbicide, if we could end up getting a pill instead, and the woman can take that, it'll make a complete difference. So, not all technology works, but you have to pick appropriate technologies that'll work in the developing world.

INSKEEP: I'd like to ask you about an argument that I'm sure you've heard at in one form or another. Some time ago on the program, we spoke with Dambisa Moyo, an economist, who wrote a book criticizing Western efforts to help Africa. And one specific example she zeroed in on was mosquito netting, which is something that you folks have been involved with providing. Obviously, it can be great for preventing mosquito bites, which can spread malaria.

But Dambisa Moyo argued that it's a very simple, cheap product that someone locally in Africa could produce and you could develop an economy and improve the standard of living in many ways. And instead a shipload of mosquito netting arrives from somewhere and makes an African country dependent on Western aid in ways that she finds counterproductive.

Mr. GATES: Well, I think it's pretty outrageous to say you ought to wait some years to create a few hundred jobs and let hundreds of thousands of children die. As you have bad health, families have more children just to increase the chance that some will survive to adulthood. You have huge population growth, which means that feeding kids, educating kids - it really becomes impossible.

So, the first intervention is to get health to be reasonable. Health aid is something that allows a country to get on its feet. It's incredible that somebody could say that it's bad for Africa to save children's lives.

Ms. GATES: Yeah, I think that's one of the things we want to make sure that we get across, is that the aid we're seeing that's going to African health is making enormous impact. So, if a mother's baby doesn't get malaria that year, she's not dealing with that disease and not having to deal with - I mean, an ill child from malaria is a horrific thing. Talk about not being able to go out and work in your field, you're there tending the baby.

Where we've got tools that work today, it makes complete sense to deliver them to the developing world.

INSKEEP: I'm just curious - and this must be very hard as very practical, successful people to admit - but has there been an occasion where you've let some foundation money out the door and after a couple of years you would say, oh, that was pretty much a failure; that was wasted money; didn't work?

Mr. GATES: Well, we've had a lot of things like that, some of which the group did their best but say it was a scientific dead end. We've had others where the group maybe didn't execute super well.

Ms. GATES: And sometimes you make a mistake where it's a fantastic investment but there's a little piece of it you didn't get right. So, a great example is rotavirus. We have, thank God, an amazing life-saving vaccine that's coming for kids. And it's actually being delivered now in Nicaragua; we're going to get it out in lots of places. It's a vaccine against diarrhea.

So, the science technology piece of it was just phenomenal - what happened. We, at the time, maybe weren't smart enough to ask for the packaging in the right way, or to make sure the system just took care of that. So, when rotavirus came out - it requires a cold chain.

INSKEEP: I'm sorry, cold chain, explain that.

Ms. GATES: Cold chain, which is you have to keep the vaccine cold all the way up until it gets up into the kid's mouth or arm.

INSKEEP: Refrigeration into very poor areas.

Ms. GATES: Refrigeration. And so at the very last piece of the mile you're carrying that thing in a backpack with a cooler, right? Well, unfortunately, the rotavirus packaging came out too large. We had these large boxes. Well, you can't carry large boxes of vials of vaccinations out into villages. That requires too much refrigeration. And so we had to go back and say, my gosh, we have to have much, much smaller vials and packaging - and that took time.

INSKEEP: That sounds like, actually, a classic example of what can go wrong with a well-intentioned project.

Ms. GATES: Sure, and so you just learn from it. And you say, okay, that's a, you know, small mistake we made; we're not going to make that mistake again.

INSKEEP: Bill and Melinda Gates, thanks very much for the time. I've enjoyed it.

Mr. GATES: Thank you.

Ms. GATES: Thank you very much.

(Soundbite of music)

INSKEEP: Bill and Melinda Gates speaking here in Washington, D.C. And by way of full disclosure, we should note that NPR receives support from the Bill and Melinda Gates Foundation.

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