2001 World Economic Forum

January 29, 2001
Remarks by Bill Gates, co-chair

I think we live in a world of greater contrasts today than ever before, and here at Davos  we've got these nice little I-pac machines connected up to a wireless network. I was on a panel this morning talking about, you know, the breakthrough things we can do with communications and education with the latest advances in the PC and these broadband networks. And there's no doubt that the breakthrough innovations coming from two sectors really are going to improve life. They're going to allow us to peruse curiosities, stay in touch, and have great health. I think the information technologies business is doing fantastic things, and I think the pharmaceutical business, broadly defined including the large companies and the small companies, are doing miracles as well, and those two things, if you go out twenty or thirty years, the impact will be very dramatic. But there's a question of whether those positive impacts will be shared broadly throughout the world.

While I'm here in Davos, and talking about great technologies, I got a chance to talk to my wife last night. She is in India visiting AIDS clinics -- and you know there's a huge contrast were you have literally millions of people in India with AIDS now. It's not known you know, will ten million die or will a hundred million die over the next fifteen years in India. And the resources exist to make it the lower bound, and yet those resources are not being applied.

When I first learned about world health, I have to say that I was kind of stunned. I half expected that the United States and other governments and foundations were really taking these low cost interventions and saying that the value of life is the same throughout the world and really focusing on that problem. And yet the more I learned about it the more I realized that there is a real market failure here. There's a failure of visibility; there's a failure of incentives; there's a failure of cooperation that has really led to a very disastrous situation. In fact, the gap in health outcomes is growing very dramatically. While the rich world is cutting down in tobacco use, it's growing in the poor world. AIDS and TB are really a phenomenon of the poor world. When I say the poor world of course I mean the majority of the world, anything outside the enclave that most of us here are privileged to live in and the kind of vaccines and things that we take for granted not only for ourselves, but also for our children.

There's an interesting explanation that Jeffery Sachs gives, where he shows this map of the world and he says, "Okay, here's the rich countries and here's the poor countries. And they're not sort of randomly distributed on this map."

In fact, you can take two explanations to account for 90% of why some countries are rich and others are poor. And that is that if you live outside of the tropical regions, the primary reason you would be poor is that you have horrible government, which in most cases meant communist governments. If you live in the tropical regions, it's very unusual to have reasonable economic development -- to have this positive cycle where you get education, stability and rule of law and the kind of long term incentives that create the kind of society that everyone should expect to live in. And a big reason why the tropical regions have that challenge is because of health issues. I don't think that it has been numerically documented as well as it should. But if we can solve these health issues the fact is that those poor countries will have every opportunity to have the same thing that we've seen happen in the last generation in countries like Korea or Taiwan where it's really an economic miracle. But if we don't solve the health problems, there is no chance that those things will take place.

This lack of visibility continues to confound me. This panel obviously, it's great of you all to come. Probably most of people here are amongst the small set of people who know and believe in these causes. The world at large, it just doesn't have that much visibility. If a plane crashes in India and kills 400 people, that will make the newspaper. People will say, "Plane crashes, four hundred people die." Well in that same day that that plane crashed, ten times as many children died unnecessarily. They died of diseases where we have vaccines today that are very inexpensive that could be delivered. You'll read about that plane crash as though that's the worst thing that happened. And the next day when there's no plane crash you won't read anything. And so because it's constant and because it's large, it just simply doesn't get much attention.

Another reason for the lack of visibility is that a lot of these diseases do not exist in the rich world. It will sound like an awful thing to say but I think we're lucky that there was at least some AIDS in the rich world so that the rich world in terms of thinking about therapies and treatments would get engaged and understand what is this disease.

We gave a grant for malaria, I think it was a fifty million dollar grant, and somebody said to me "That's going to cause a fifty percent increase in the amount of research that goes on in malaria."

And I said, "That is the most horrific thing I've ever heard. How can that be true?"

Malaria causes, more than any other single disease, more lack of productivity. It happens to kill young children and pregnant mothers quite a bit but the actual loss goes way beyond the deaths that are caused. It's only recently that people are begging to come up with good statistics to illustrate the burden that something like malaria causes. It is absolutely outrageous how little has been put into research on malaria.

If you look at the AIDS picture, the amount of money that has gone into the vaccine side of things is very very limited. Fortunately it looks like that can be changed. There's a challenge out there to raise some more money and get that visibility.

Tuberculosis—the vaccine hasn't been worked on and yet if there was a breakthrough there, the savings could be incredible.

So I think we all have to think creatively: how can we make this more visible? I bet there's something that everyone in this room can do related to the visibility of this problem.

We think, okay, philanthropy—there must be a lot of philanthropy involved in this. I was stunned to find that only about two percent of the philanthropy in the United States has to do with taking resources from the richest country and making them available to the poorest countries. Philanthropy is overwhelmingly—there is nothing wrong with it—but it's from the richest country to the richest country. I was pretty stunned to look at a comparison of different countries and see the US and many other rich countries way at the bottom of the chart.

People if they are told about these diseases that don't exist much in the US -- if we just showed a ten minute video on trachoma, which if you had to rank things, might be fifteenth or sixteenth in the horrible conditions that the poor countries have to live with. If you just saw that alone and people sort of pulling out their eyelashes and going blind you'd say, "Boy I want to really get involved in that. I want to lobby my government to do more about that. I want to get more partnerships going on around that." And yet it has very low visibility.

I'm not trying to paint a totally bleak picture here. I think there is a renaissance here in terms of thinking about these things. I think we're early in that renaissance. There were a few things done in the US last year to get a little bit more money in this direction. The US should strive to be, say, half as good as countries like Norway, Denmark, Finland, Sweden, The Netherlands—those five—I don't think I left anybody out—but there's a number that are really very good. The US should strive to be half as good in terms of donations per citizen, which would be more than a tripling of the amount of resources that would go into this.

The pharmaceutical companies really need to be part of these partnerships. And they have done some good things. They are very open-minded to more things that can be done and how they can help out. That's not a simple issue, because you've got to keep as much incentive as possible to create the breakthrough drugs. The benefits to society of the rich world at least focusing on the diseases that are common world wide—that's a fantastic thing. And so there's a lot of good news about the advancements taking place in some of these new partnerships. There are some areas of bad news. Things like AIDS and TB that we haven't gotten our hands around.

So, I just make a plea that corporations in general need to get this on their agenda. I know for the final push on polio we're going to go out and see if we can't get more companies involved. Rotary International has been just an unbelievable organization in helping with that polio thing. What they've done is really kind of unprecedented and we need to draw more people in to get to the final push on that.

I'm very optimistic that we will craft these new partnerships and we will start to see what is the greatest inequity in the world. The thing that we all care about—inequities across women and men, inequities across races—but the biggest inequity, by a factor of ten, is the difference in availability of good health, which is sort of a geographic and economic divide that is quite phenomenal.

People are a little surprised that my focus in philanthropy—over sixty percent of what the foundation's doing relates to world health. It doesn't relate to computers and software. We do some of that with the rest of our resources and we do some wonderful things there. But I've decided the thing that counts the most is world health and all of you here are helping with that—I give my thanks.