NEAL CONAN, host:
This is TALK OF THE NATION. I'm Neal Conan in Washington.
When Bill Gates created what would become the world's largest charitable foundation, he wanted to transform the business of philanthropy the same way he revolutionized the software industry.
The Bill and Melinda Gates Foundation uses a business model focused on results and accountability, and the scale is huge. The endowment is estimated at more than $30 billion. It gives almost as much money to global health every year as the World Health Organization.
Today, Bill Gates released his second annual update on the foundation and its work, and he sees progress. More children got routine vaccines, HIV spread more slowly, public schoolteachers got new incentives to approve. He also acknowledges challenges: the global economic downturn and the disaster in Haiti, to name just two.
Major themes of this year's letter: innovation, taking risks, using technology, funding new ideas.
Bill Gates joins us to talk about all of these things and, of course, the criticisms that are inevitable when you wield this much money and this much influence.
Later on the Opinion Page, an argument that donors need to let Haitians take the lead in the reconstruction of their country, but first, if you'd like to talk with Bill Gates about his foundation and what it does, give us a call, 800-989-8255. The email address is firstname.lastname@example.org. And you can also join the conversation on our Web site. That's at npr.org. Click on TALK OF THE NATION.
Bill Gates is co-chair and trustee of the Bill and Melinda Gates Foundation and joins us here in our bureau in New York. Nice to have you on TALK OF THE NATION today.
Mr.�BILL GATES (Co-Chair, Trustee, Bill and Melinda Gates Foundation): Great to be here.
CONAN: And let's begin with Haiti. I know the foundation has donated more than a million dollars for relief. How do you decide how much, and how do you where it goes?
Mr.�GATES: Well, our foundation is focused on two big things: the needs of the poor, which are global; and here in the U.S., we've picked education.
For the poorest, that ends up being health, primarily, but also some things having to do with agriculture or helping them with savings, anything to lift them out and allow them to be self-supporting, and so that that's our big focus.
We do save money for disasters that come along. A big thing we like to do is support those organizations even before the disaster hits so that they're training doctors, they've got supplies in warehouses, and they have capacity so that they can respond very quickly.
CONAN: A million dollars or more than a million dollars sounds like a lot of money to most people. They say Bill Gates, come on, he could give billions if he wanted to.
Mr.�GATES: Well, our foundation does give away a little over $3 billion a year. That's the gift that Warren Buffett provided, along with the money I earned from the success of Microsoft, and so we are able to do a lot of things, but yet compared to the needs, or even what the U.S. government or other big governments spend, it's actually quite small.
CONAN: And looking at your letter, you're focused more on longer-term issues than short-term issues like water or food for people in need in Haiti at the moment.
Mr.�GATES: We are part of this disaster relief, and it's wonderful to see that almost half of American families have made some type of donation for this disaster.
I've been to Haiti several times, and even before this, it was a place that needed a lot of support. Partners in Health, one of the groups we've given to, has got Paul Farmer(ph) - who's this incredible doctor who has done fantastic work - down there. So you know, we'll need to stay focused on Haiti, not just this month, but in the years ahead.
Foundations do play a unique role. There are things like funding risky vaccines or new approaches, where they're probably better set up to do it than governments are. So the work is complementary to the work of various governments.
CONAN: Rajiv Shah used to work for you at the foundation, as of late December, the administrator of USAID in the Obama administration. In his first month on the job, of course, he's presented with this enormous natural calamity in Haiti. I wonder, have you talked with him about that? Have you given any advice?
Mr.�GATES: I know Raj is very busy getting USAID strengthened, and now this Haiti thing's come along. So I haven't talked to him. I did send him a congratulation note on his new job. He's very talented. He was a great pick for the job.
CONAN: And let me bring you this question that we got by email from Lynn(ph) in Seattle: Thank you for your superlative philanthropic work. You're a leader, truly, and a humanitarian. Many of the challenges faced by the poorest countries now and faced by the entire globe of the not-distant future are brought about by larger populations than can be sustained by resources available.
Part of the solution lies in better resource management. Also important is limiting population growth, yet your vigorous and effective health care efforts are going to result in reduced mortality rates, therefore significant population increase. How do you reconcile the discrepancy?
Mr.�GATES: That's a concern I had when we got started, was that if you improved health, you'd grow the population, and what I found out, that even though that seems like common sense, sort of Malthusian, it's the opposite of the truth.
That is, any country where health improves, the mothers choose to have far less children. So in the world today, we have places that are well off with very little population growth, and we have places that are in terrible shape that have high population growth.
So within 20 years of improving health, the birth rates go down, and so that meant we could not just fund reproductive health work, which has always been a big focus for us, but also do these other health measures and know that it would not only benefit this generation but future generations, as well, because I completely agree with the questioner.
The idea that health reduces population growth means all the things we care about feeding, education, jobs become possible when you're not growing the population too rapidly.
CONAN: Your term, innovation, comes up repeatedly in your letter that was released today. I wonder: Is there one project that you're especially excited about?
Mr.�GATES: Well, in the U.S., we have two big projects that we hope will improve education. One is working with teachers to come up with a measurement system that gives some feedback on where they could improve and helps them know how effective they're being. I think that would be a wonderful thing, and so we've funded some experiments that are being done with teachers on that.
Another is having the world's best courses on line so you can see the lectures, you can test your knowledge, and we're putting money into that.
And I do think we need to have innovations in education because that great four-year degree that everybody should want is becoming far more expensive. Even the state schools...
CONAN: To get a college degree.
Mr.�GATES: College degree. They're raising the tuition rates at all these great state schools that were the most accessible, and so it's becoming out of reach for even the middle class. So only through innovation are we going to make education far more accessible than it is right now.
CONAN: And the Web is the way to do that, do you think?
Mr.�GATES: Well, the Web will be part of it. Of course, it's revolutionized many things. It hasn't changed education dramatically, yet, but I think there's an opportunity there. I go online to sites like academicgrowth.org, find courses and watch them, and if we get more of those and make them easy to find, make it clear what their prerequisites are, I think both teachers who want to learn how to do it better and some students will directly take advantage of that.
CONAN: One of the projects you talk about, and you talk about high risk, is a vaccine to prevent HIV, and this has been something that people have been thinking about and working about for a long time. What gives you belief that it's actually going to happen this time?
Mr.�GATES: Well, the U.S. government is the biggest supporter of an AIDS vaccine. We also spend hundreds of millions a year on that. And there was a trial that reported this last year, the so-called TIDE trial, that showed some results, quite modest, but they made everybody feel very good that shows a vaccine is possible.
We also now understand a lot more about the disease, some antibodies that'll let us build a good vaccine. So even though it'll probably take more than a decade, I'm quite sure that we'll get one, and we need it. It's the tool that will help us end that epidemic.
There's a lot we need to do in the meantime about prevention and treatment, but the vaccine would be the ultimate. In fact, the foundation, our biggest single area is helping to invent these vaccines and then helping them get delivered to people.
CONAN: Helping them get delivered, some of your critics say you concentrate on the product, a great new vaccine, and don't focus enough - or give enough balance, as they would put it - to the delivery systems. Having a vaccine doesn't mean anything if there's nobody to put a needle in somebody's arm.
Mr.�GATES: Well, that's absolutely right. So we have put over a billion and a half into vaccine delivery. We put even more into vaccine discovery, and you've got to have both.
There are some new vaccines now, one for a diarrheal disease called rotavirus, one for a respiratory disease, pneumococcus. We need to get those out there. Those, between them, could save over 400,000 lives a year.
But we should also invent a malaria vaccine and a TB and an AIDS vaccine, and so we've got to pick, and we've put a lot into both areas.
CONAN: There's also something that I was surprised to see the foundation would be involved in, and that is somehow getting people to believe in savings accounts. What's the purpose there?
Mr.�GATES: Well, if you're a poor person, you go through periods where you don't have enough money. And so how do you save? How do you get ahead for those bad events?
If you're wealthy, banks provide that service. They hold your money; when you need it, they give it back to you. But if you're poor, the transaction fees, the complexity, the location, the banks just aren't there, and so it's awful.
If we could let people who are poor have savings, say through a mobile phone, then they would be far better off. And we have one country, Kenya, where that's actually starting to work. It's being done on the mobile phone. It's called M-PESA.
So we're looking at what the magic was that let it happen there and how we can spread that around and get it to be more widely used.
CONAN: The penetration of that technology, mobile phones, throughout very poor areas of the world is incredible.
Mr.�GATES: That's right. It's a product that people use. Not everyone has one. There's a tendency to share, but even in rural villages throughout the world, there are cell phones, and that's been very empowering for the people in those villages. Now we just want to use that phone for even more than just voice calls.
CONAN: Quick comment from Kurt(ph), who wrote this on The Two-Way, NPR's news blog: Thanks for your incredible work. As a writer and polio survivor, I try to bring about awareness for those affected and work for eradication. But what about those who need medical advice? Most of the polio doctors are gone.
Mr.�GATES: Well, polio is hopefully on its last legs. We've got the last one percent, and last year we made good progress, but it'll still be a number of years before we'll be able to declare victory on that.
It's fair to say as there's less victims, understanding what you do for the people who are suffering, we've got to make sure that expertise is maintained. Hopefully, we're just not going to be adding to the number of victims at all.
CONAN: Our guest today is Bill Gates. We're talking with him about his charitable work, the financial crisis, the challenges in Haiti, and when we come back, we'll take some of your calls, 800-989-8255. You can also zap us an email. The address is email@example.com. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.
(Soundbite of music)
CONAN: This is TALK OF THE NATION. I'm Neal Conan in New York today with Bill Gates, the co-chair of the Bill and Melinda Gates Foundation, the world's largest charity. It distributes billions of dollars every year in grants. Among its many recipients, the foundation has generously supported NPR News for several years.
Today, Bill Gates released his second annual update on the foundation and its work. You can find a link to that letter if you'd like to read it at our Web site. That's at npr.org. Click on TALK OF THE NATION.
And we're taking your calls today. If you'd like to talk with Bill Gates about his foundation and what it does, our phone number is 800-989-8255. Email us, firstname.lastname@example.org. You can also join the conversation at that aforementioned Web site, npr.org. Just click on TALK OF THE NATION.
And let's see if we can get a caller on the line, and we'll begin with Amita(ph) is with us from San Francisco.
AMITA (Caller): Hello, thank you so much for taking my call.
AMITA: I used to work in public health, and a very interesting study that came out some time ago, looking at the impact of HIV among women in third-world countries. And it showed that one of the ways to empower them and build their ability to protect themselves against HIV was actually through economic development, supporting their small-business endeavors and just making them more empowered financially.
And I'm curious if this is something which (unintelligible) is funding anything in terms of economic development among women in third-world countries.
Mr.�GATES: Yeah, we have a whole group that does things in addition to our health work to help the poorest get out of poverty. A lot of that is in the agricultural sector. The majority of poor people in the world are farmers. Most people don't know that the women are doing most of that work, and so we're giving them new seeds, new techniques. We're also involved in microfinance and savings, and when you give women those tools, they use them very effectively.
You know, for AIDS, if it was just for AIDS, I don't think that alone would justify this, but as you improve health, then you want to compliment it with things that they can earn their own livelihood and support themselves. So growing those economies is a big focus of our work.
AMITA: That's wonderful. Well, thank you so much for your leadership in the field, appreciate it.
CONAN: Thanks for the call, Amita. Let me just do a follow-up. You mentioned help for farmers, and that includes better seeds. For example, a drought-resistant corn would help a lot of people. This would be a genetically manipulated product, as I understand it, and there is resistance to that around the world.
You were talking about polio before. There is resistance to taking the polio vaccine in some places. There is all kinds of problems delivering help, treatment for people with AIDS because they don't even want to admit they have AIDS in some countries. How do you get around some of these issues, behavioral issues about people?
Mr.�GATES: Well, making sure people demand vaccines for their kids is very, very important to us. As you said, there was a rumor spread -primarily in Nigeria - that the polio vaccine was a plot from the West, it would sterilize women, and that had a terrible effect because very few people took the vaccine for the years after that.
Now fortunately, we've gotten beyond that. We're getting people to take the vaccine, and so the number of cases is going back down again, but there's always rumors that undermine the vaccine system. Explaining the benefits, because if coverage go down, you know, kids start to get measles or ptosis.
CONAN: Seeing that in this country, yeah.
Mr.�GATES: In every country. I mean, the numbers are by far worse in the poorer countries, but we need that message everywhere. For something like AIDS, the stigma, getting people to come in for treatment, is often quite difficult, but the more people who come in for treatment, the more it becomes broadly acceptable, and so there has been some progress.
CONAN: Let's get another caller on the line, and this is Evelyn(ph) from Penney Farms in Florida.
EVELYN (Caller): Right. First of all, I'd like to commend you, Mr.�Gates, for your interest in education. I'm a longtime educator. I spent 30 years in Detroit Public Schools, and I spent eight years in Haiti teaching teachers.
EVELYN: So I'm really encouraged by your interest, and I went to my grandson's graduation and was very pleased to hear them announce the scholarships that you give to the youngsters. But I had an idea. What about gearing some money for training persons here in the States who will pledge to and be prepared to go to third-world countries to help them in their efforts to get them to be able to be self-sufficient?
Mr.�GATES: Well, I think it's very important that as many of us go out into these countries both to help and both to understand so we can come back and bring that awareness to the rest of the country, where we tend to take things for granted, whether it's having a toilet or medicines or shelter.
Groups like the Peace Corps are great for young kids to get out there. We're not doing a youth corps thing ourselves, but it's a fantastic idea. I mean, you know, going down to teach in Haiti, you know, that was a fantastic contribution. You know, Haiti's going to need a lot more help, and it's not going to just be in the next year.
So I am seeing more interest from kids in this, and the idea of giving them clear outlets, I think we need to put more into that.
EVELYN: Yeah, I think that would be great. You know, with my voc ed background and so forth, I know that when the youngsters know that this is a skill that I'm going to be able to use and make a living from and then, now, the added emphasis because believe me, there's a lot of interest that I've talked to young people in what's going on in Haiti and other places they would be more than happy to say yes, I'll spend a year, two years training myself so that I will be ready to go and help them.
CONAN: And Evelyn, when you say voc ed, that's vocational education, I assume?
CONAN: Okay, all right, well, thanks very much for the call, appreciate it.
EVELYN: My pleasure.
CONAN: Here's an email, this from Blaine(ph) in Osceola, Indiana. First, let me say I think you're a terrific innovator of our century that's not a very old century yet, but anyway I hope you can further bring people advancements and help improve their lives. Wouldn't it be easier to pick larger, more prominent issues instead of trying to fix everything at once, i.e., water, food, malaria, AIDS, housing, Internet, et cetera.
I know your foundation funds all of these things, and blessed be you that you are as charitable as you are. However, isn't it easier to take these vast resources to target, say, AIDS, one fixed, move on to the next problem.
Mr.�GATES: I think a lot of charities probably should take less things on and take them on in more depth, and we're constantly talking about, you know, are we picking the right topics? Over half of what we spend is on global health, and that's about 15 diseases, where AIDS would be the top of the list, and then malaria and TB would be number two and number three.
So we think, given our size, given our background, the you know, we picked the right number of things. As we're seeing each year where we're having impact, you know, we need to be open, but I think global health and education we'll be working on the rest of my life. And I think it's good to have somewhat of a portfolio because like on malaria, there's a lot of things to be done, but you know, so we've decided to do some of this work in parallel instead of just one thing at a time.
CONAN: Let's go next to James(ph), James with us from San Antonio.
JAMES (Caller): Hi, thanks for taking my call.
JAMES: I just wanted to commend Mr.�Gates for spending his money on charities and not grotesque mega-yachts like some of his peers. I just wanted to ask him if he had ever thought about possibly combating poverty in the States.
Obviously, we don't have the kind of crippling poverty that they have in third-world countries, but I know in my family and just around San Antonio, Texas, we've been hit hard, and there's some pretty serious poverty issues. If he could comment to that.
Mr.�GATES: Well, absolutely. We wanted to pick the cause that we thought would make the most difference for the U.S. and make sure we were putting a lot of resources into that, and we picked education, and I think if we could improve the K-through-12 system, if we can make college more accessible, the persistent poverty we see, that is the best solution for it.
If you go to a bad high school, if you're not encouraged to learn, if you drop out of high school, your prospects are getting worse. There aren't the kind of jobs that blue-collar-type background, the opportunities just aren't as great. And so the education system has to change. It has to get more people with a broader set of skills.
So through the education system, we hope to reduce that lack of opportunity and poverty.
JAMES: Thanks so much for taking my call. I really appreciate it.
CONAN: James, thanks for the call. This email from Ron(ph) in San Francisco: Many countries appear unable to handle, effectively or ethically, the amount of money they receive for assistance. What are your thoughts about governance and how the foundation could support it where it's weak or instill it where it doesn't exist?
Mr.�GATES: Yeah, it's a very good question, because good governance has a huge impact on a country. If you have a government that takes a long-term view, it's honest, it invests in the roads and the schools, then things can improve a lot, and some countries have had that and done very well, but many have had terrible governance.
Unfortunately, a poor country has a harder time getting the consensus, getting good leadership and so poverty tends to lead to bad governance and bad governance tends to lead the poverty.
There's a writer, Paul Collier, who talks about these issues and how break that cycle. Improving health is one way. Backing groups in the country so that they can speak out is another way to do it. We haven't come up with a magic solution to improve governance, but we back groups like Transparency International that track government budgets, talk about corruption, report other countries who are not doing that well.
CONAN: Let me just ask you specifically about a country like Zimbabwe, which has terrible, terrible poverty and many, many problems and a terrible government, not to put too fine a point on it. Are you involved in Zimbabwe? Do you think about any money we put in there is going to be wasted?
Mr. GATES: Well, we do put vaccination money into Zimbabwe, but we don't do it through that government. We found NGOs that are actually involved in doing that delivery and so that we've been able to maintain that.
Vaccinations are one of the few things you can do even when you have a terrible government. Building roads, you can't do. Really, building agricultural sectors are very hard to do. But preventing vaccine-caused diseases, even in an area like Somalia where there's hardly any government, the vaccination rates have been kept reasonably high.
CONAN: Here's another email. This from Linda in Princeton. I'm a big fan of Mr. Gates' philanthropic works. This makes me wonder about his legacy. Would he prefer to be remembered most of his work at Microsoft or through the Gates Foundation?
Mr. GATES: Well, I don't care about being remembered. In fact, you know, our foundation will spend all its money not too long after - whenever Melinda and I aren't around because, you know, we know there's a lot of problems today. And whatever problems are out in the future, the rich people in that time will know more about them and can be focused rather than...
CONAN: So, you don't intend this as a - the foundation itself as a legacy?
Mr. GATES: No. The foundation should spend all its money and go out of business and then other foundations will come along. I can't craft in my will some words that anticipate the problems of the future. And I know how intense the needs are today and so I won't be in perpetuity. You know, I we just haven't chosen to do it that way. And Warren Buffett, who's provided a lot of our resources feels the same way. He has the same plan.
CONAN: We talk today with Bill Gates of the Bill & Melinda Gates Foundation, used to be with Microsoft might've heard of him.
You're listening to TALK OF THE NATION from NPR News.
And here's an e-mail we have from Steven(ph). In the United States and many developing countries, diabetes and childhood obesity has become an epidemic. Does the Bill & Melinda Gates Foundation attempt to tackle these issues? What issues are you tackling within the U.S.? Well, you mentioned education is the big one, but obesity?
Mr. GATES: No, here in the U.S. our focus is on education. And in our global health work it's almost entirely infectious diseases. The question is absolutely right, obesity is growing not just in the U.S., but even in Mexico and India. And we're hopeful there'll be a breakthrough there. But, you now, we've chosen in terms of - we've got a lot of diseases: malaria, AIDS, TB. So until we make breakthroughs on those, we're going to stay focused on those.
And, you know, I hope other foundations - the market will drive the inventions of ways to avoid diabetes because the costs and the suffering that are going to come as that grows will be really awful.
CONAN: Let me ask you a question about the methodological philosophy, the results-based philosophy. How do you measure some things? I mean, we know for example that the number of children under five who've died in the past year is lower. How do you know that's attributable to vaccines?
Mr. GATES: Well, there's no doubt that it's due to vaccines because I have a pie chart in my annual letter that just came out today that shows us the causes of death for children under five. And there you'll see a part that's about diarrhea. Well, there have been vaccines that get rid of some of that. Malaria, you'll see is at eight percent of those deaths. Well, the arrival of bed nets in the countries that have put them out extensively have cut malaria deaths in half.
So we have fairly good statistics that - where we can say, if you go out after this disease, do you have results? And basically, we - money put into these areas, you save lives for less than $10,000 per life, which is, say, a hundredth of what the U.S. would spend to save a life. So it's pretty impactful. Some of the vaccine stuff is down as little as $2,000 per life saved. And so it'd be crazy not to do it.
CONAN: Some people - your organization does so much, the foundation does so much and has such a presence that some people feel it is distorting and even skewing other foundations' work, other governments' work. They're saying, well, Gates is doing this, I don't have to worry about that and they shift over. Is the size, the very size of your foundation in some ways a drawback?
Mr. GATES: Well, we measure, are we being catalytic getting other people to come into these areas? So, 10 years ago, the U.S. government gave a billion dollars to global health aid, now that's up over $8 billion. And we don't take credit for that, but the visibility of the success stories that we and others have had, I think has helped allow the politicians to say, yes, we take foreign aid and it's not just so much about Cold War politics. We're willing to put it into this part of aid that really, really works.
You know, a lot of that's gone into AIDS medicine, so there's hundreds of thousands of people alive who wouldn't be alive. Foundations as a whole are giving more to global health. And so this - getting those success stories out there builds a positive sense. And if weren't able to encourage more money to be in, I'd be very, very disappointed.
CONAN: There's also - you described learning from your mistakes and failures. What have you learned from the most?
Mr. GATES: Well, we're often naive. I, you know, approach things with an optimistic view. And I thought once we invented new vaccines, getting countries to adopt them and add them to the set they give to all the newborns...
Mr. GATES: ...would be straightforward. It turns out it's going to be way, way harder than I expected. And we're having to, you know, if we'd understood how hard it would be, we would've started sooner. So it's a mistake. It's a failure attributable to me that I didn't know that. Now we're trying to catch up, you know, meet the goals that we had. But, you know, every year that goes by you don't get these vaccines out, you measure it in terms of hundreds of thousands of children who die.
CONAN: We're going to end with this email from Edmond - from Ken in Edmond, Oklahoma. I'm a Kenyan in the USA. I would like to thank Bill & Melinda Gates Foundation among others who have done great work to eradicate disease and poverty in our small villages. My family has been a direct beneficiary. Thank you from the bottom of my heart.
And Bill Gates, thank you very much for being with us today. We appreciate it.
Mr. GATES: Thank you.
CONAN: Coming up, Haiti on the Opinion Page. We'll hear an argument that rebuilding in that country must be led by Haitians. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.