Creating Digital Dividends Conference

MR. GATES: Some of these numbers are a little hard to appreciate. Somebody got up and spoke about we could save eight lives, it would be very direct, if we could put eight pictures on the screen and say, come on, we should save those eight lives. But, when it gets to 80, or 8,000, or 80,000, or 800,000 or 8 million, as you get those orders of magnitude increase it's almost like you really can't directly relate to it. It's always interesting, you read the newspaper and it will say there was a bus crash and 37 people died in some country in the world. But, every day of the year they could also run an article that says, today 15,000 children died who shouldn't die. And that's a huge, huge number, but because it's constant it's not news, it's just the way things are.

And so in some ways it's sort of below the surface. You might think, what about these great advances in medical technology, all the new biotech companies and the advances in these pharmaceutical companies, well, in fact 95 percent of the money spent on health research is spent on the problems of the richest 1 billion of the 6 billion, and only 5 percent is spent on the other. So you might say, we must be increasing that. Well, in fact, over the last decade the U.S.'s giving to world health causes, world health research has actually gone down. And in the last five years since we've had these budget surpluses and really the greatest prosperity we've ever had, those numbers have continued to go down.

And so it is a very challenging thing. It's one of these things that when you dig into it and see where it is you begin to think, this is a little depressing. But, in fact, the opportunity to improve it is still very dramatic. There are other elements that are pretty challenging. AIDS, you probably know, has lowered the life expectancy in a lot of these countries very dramatically. A country like Botswana now down to about 45 years life expectancy and still going down, from about 60. And once the epidemic has spread, it's very difficult, there really is no great solution.

Most of the money that's been spent on AIDS research, over 90 percent, has been spent on treatment and not the vaccine. And the vaccine effort is just getting going, and even with good luck it will take over a decade of work, although there are some people more optimistic than that. The average consensus, even optimistic view would be that. So the 12 million people a year who are contracting HIV won't be able to avoid -- all those people will eventually die of the disease. And for many of these countries, what that means in terms of infrastructure is pretty dramatic.

In any case, let me not dwell on that, although there are many books that are very good that write about these things. Nowadays when people ask me what I'm reading, it's not quite exciting to tell them, I'm reading about the evolution of infectious diseases, or the history of malaria. I haven't gotten many people enthused about reading these things, but once you get into it it's really quite fascinating. So what's the outlook here? Well, the outlook is that particularly as people become aware of what the real situation is, the incredible disparity, and the gaps, the gaps in terms of living conditions are much more dramatic than I think at least on a daily basis we think about, or that we prioritize our activities around.

But, it certainly is true that advances in technology, that is getting -- being able to survey the information better, being able to get information out to doctors, being able to train doctors, being able to make these breakthrough medicines, if we increase that 5 percent on poor world diseases to, say, 10 or 15 percent, there's no doubt that over time, which means a 20 or 30 year time frame, for all of those diseases of the poor world we can come up with vaccines or medicines that will greatly reduce them, and have the kind of health equity that we talked about, where the richest 1 billion and the other 5 billion are, from a health point of view, from having children that are able to achieve their potential, that that's equal around the world.

This is not something that there's any one quick solution to, or any simple solution to it. People talk about very clever ideas, of tapping entrepreneurialism, and having economic incentives go after some of these problems, that is very, very important. But, it alone won't deal with these problems. We're going to have to have a lot of government involvement, we're going to have to have a lot more philanthropy than we've ever had in the past, giving whether it's at the individual level or at the corporate level, that's going to be critical.

Jeffrey Sachs talks about the idea that if you could raise that richest 1 billion to give something like $20 to $40 each per year, which is a dramatic increase over what goes on today. If you survey people in the U.S. what they think the U.S. government is doing versus what they're actually doing there's about a factor of 10 difference there. But, at $20 to $40 per year that could raise that research level and the delivery systems and do some incredible things. And so it would all come together, if you get health then you have opportunity for literacy. Health first, then literacy, once you have literacy then you have a chance to bring in the new tools of communication. Let people reach out and have access to the latest advances.

It is really gratifying, for example, to visit India now and see that because they've had good educational institutions, and they've had a focus on it, there are more and more people in India participating in the world economy. And the fact that the world has had this shortage of people with great IT training, the Indian institutions have stepped up to that. I was there about four weeks ago, and it was amazing the chief ministers of the various state governments all came to lunch and they were all basically competing to say which of them was doing the most advanced work. And it's a very healthy form of competition, governments actually doing rational, forward looking things, taking short term sacrifices in order to really shape things up. And particularly in the case of India that's a dynamic that I think is going to have an absolutely huge impact.

So I have a very positive view of where all this will go, including the health elements, including the digital elements. I want to say thanks to all of you who are here talking about this, thinking about this. It's through events like this that we're going to get the kind of attention and therefore the progress that these topics really deserve.

So thank you.

(Applause.)

QUESTION: Thank you very much, Bill.

And your questions for Bill Gates welcome, using our card system that we've been using throughout the conference. Bill, very interesting that you're interested in health now, and that you were so taken by what Ted Turner said about, we need health more than we need PCs in these places. It reminds me of a village I visited once on the Southwest coast of India, where 10 percent of the people had elephantiasis, which is a hideous, mosquito borne disease, similar to malaria in the way it's transmitted.

And it turned out that the reason they had this malaria was because they were soaking coconuts in a pond in order to spin that coconut husk into this hairy kind of rope that you see made in India in hardware stores all over the world. And so it turned out there was an economic solution to their health problem, drain the pond and find something else for them to do, and this could greatly improve their health. I was a journalist, I wrote that story, I went on my way. I don't know if they ever drained the pond or not.

But, the point is that in a world where you have a new sort of economy developing that is in orbit around the PC, isn't there a health enhancing aspect to introducing the PC, and helping people step away from this tote and bare kind of lifestyle that is so inimical to health, and helping them to achieve a higher standard of living through being involved in a higher quality of effort in their life than what they've been used to. I'm suggesting that closing the digital divide has significant health improving aspects.

MR. GATES: Let's say you've gone to that village, people who have lymphatic filariasis, which is the name for elephantiasis, they're not going to be using the PC. I mean, they're not. You really have to deal with the basic issue of their health, and their ability to just have -- they're not going to become literate if they don't have good health. So, yes, the PC fits into that. But, whenever you come up with a specific disease problem, and the number of people affected by it, that certainly has got to take priority over saying, for that particular person, let's get them a PC.

QUESTION: Okay. First of all, suggesting that unless they have good health they're not going to be literate, this has been discussed in spades at this conference the past couple of days. That doesn't seem to be the case.

MR. GATES: What doesn't seem to be the case?

QUESTION: That unless they have good health they will not be -- they must have good health in order to become literate. We discussed that here, and that -- 

MR. GATES: And you solved that one?

(Laughter.)

QUESTION: Well, we haven't exactly solved it, but it's just not true.

MR. GATES: What about death?

QUESTION: And the idea -- 

(Laughter.)

QUESTION: And the idea that they won't use PCs we've also discussed at some depth. And the discovery is that provided with access and an economic purpose, you'd be surprised who will use PCs. I hope you see the special report on this we're going to put in Business Week, because you'll be surprised at who is using PCs, and who is very desirous of using your technology out there.

MR. GATES: I think I am a big believer in PCs.

(Applause.)

QUESTION: Why do we have to choose between investing in a malaria cure as opposed to working to close the digital divide? I mean, especially in your case, you've got the foundation, you've got the company foundation, you've got your personal foundation, your company foundation, and then also corporate activity on a for profit basis, all of these things could be turned to both of these purposes, couldn't they?

MR. GATES: Well, certainly if you take -- there can be parallel investments, and there should be parallel investments. I am suggesting that if somebody is interested in equity that you wouldn't spend more than 20 percent of your time talking about access to computers, that you'd get back to literacy and health and things like that. So the balance that makes sense is that more money should be spent on malaria. I mean, it's almost criminal that more money isn't spent on new drugs for that. A million children a year die from it. The effect on people's lives is quite dramatic for about 20 million people.

So I think what we've done in the foundation is we're putting about 60 percent of our resources into world health, and about 30 percent into things like the education and library programs that are also very important. But, it's a different balance than someone might have expected, or I would have expected that I would be involved before I got reading about this stuff and thinking about this stuff I would have thought, okay, let's just give everybody a computer, and that's it.

QUESTION: So many questions. A lot of these are ideas for you to invest in.

MR. GATES: Good.

QUESTION: The idea that you need literacy to benefit from technology, the questioner asks about icon based interfaces, and whether Microsoft might be interested in creating such.

MR. GATES: Well, I think that's a good thing. But, you need literacy. Yet, there are certain things you can get out of a device by having speech recognition and all that. But, if somebody is saying, okay, now it's time we can just skip this whole literacy thing, I really disagree with that. The fundamental benefits of having a tool like this, 99 percent of the benefits come when you've provided reasonable health and literacy to the person who is going to sit down and use it.

QUESTION: The questioner has helped me to say what I was trying to say earlier. Economic development is the precursor to health. To come in as some sort of flying saucer --

MR. GATES: That's not true.