Global Foundation Address

September 12, 2000

Remarks by Bill Gates, co-chair

Good evening. Thank you Gus, and thank you to the Excellencies and Ministers who are in attendance tonight, and to David Miles, the Chair of The Global Foundation, which made this evening possible.

It's great to be among so many people who care deeply about these important issues. This is actually the first talk I've ever given touching on the foundation and the health-giving that we've been doing.

All day long I've been talking about the wonders of new technology and software. That's a very familiar thing for me, because I feel it very passionately but no more passionately than I feel about the causes that we're talking about tonight.

It's great to be here in Australia. My wife and I will have a chance to take a few weeks off and see a week of the Games. We're very much looking forward to that. The Games were last here in Melbourne back in 1956. I was one year old at the time, the same age as my son is right now. But it's interesting to think how the world has changed since then, and it's changed in some very, very positive ways. If you think of health, if you think of the situation that women are in, if you think of access to technology that lets people pursue their curiosity, we have come a long ways. And I think people who fail to see this rate of improvement and fail to have a lot of optimism about where it's going really are missing exactly what is going on.

My chosen field of work, building software, is certainly one of the big change agents that's driving this forward and even 25 years into my career at Microsoft I'd say we're not even halfway to what we can achieve. Sitting down with kids like we have today and talking to them about how they use personal computers and how they just take for granted, how they can just reach out to other people and pursue the topics they care about, it's a phenomenal thing. It's a thing I didn't have as a student growing up and it was really part of the dream of creating Microsoft that we could really make that happen and carry that forward.

So the good news here is that we can have incredible advances in medicine and technology. In fact, these things are so wonderful that we have to turn around immediately and say, 'what can we do to get broad access to these advances?' They're so important that everybody ought to have, it almost should be a basic human right to have these things, and we ought to set goals on a global basis for when we are able to distribute these things in a truly equitable fashion.

I decided at a very young age before Microsoft had risen to a level of success that I hadn't expected, that whatever wealth I had I would want to give back to society. It really had to do both with a desire to give to good causes but also a belief about not wanting my children to grow up with that burden. They may have a different view of it but, I made that decision before they could really represent their point of view so, it's a little bit late for them!

I definitely saw myself at a young age as waiting until I was probably in my 50s or 60s before I got significantly involved in philanthropy. But I started out doing some things in the population area and I started asking questions about health and what was going on in health. And you could say in a sense what I found out was bad news. I found out that the world is not as focused on this as it probably should be. And it was really based on that that I decided to accelerate the creation of the foundation on a measurable scale and go after health problems.

People might ask why I am doing philanthropy that is largely targeting poor countries of the world. Many of the foundations around the world primarily target the same rich country where the wealth was earned and although I have no dispute with that - I think it's fine - I think the balance ought to weigh more heavily in favor of the true inequities that exists on a fairly global basis. Warren Buffett is a good friend of mine and I often talk to him about this. He's also committed to putting his wealth into a foundation although he finds the idea of mixing the mentality of making money and giving money, he finds that schizophrenic! I admit, you've got to be careful not to bring one approach to one thing. If you mix them up you'll going to get it all messed up so I try to keep those two things separate.

In any case, he and I talked about what should be the criteria for giving and one idea he came up with that I think is pretty interesting, is that before you think about what giving makes sense you might consider yourself --think of yourself as somebody who's going to be born to an arbitrary womb, just randomly selected anywhere in the world. And what would you want to do – what changes would you want to make in the world, knowing that you're going to come into the world, you don't know what country, what sex, anything but that you're just going to be one of 6 billion citizens here. And certainly taking that perspective, you'd step back and say wow, it's really unusual, the billion people in the rich countries have health and access to very basic things that a high percentage of the 5 billion do not, and that cause I think would rise above all others.

Many people would have expected most of my giving could be in the area of 'let's give everyone personal computers, let's make sure they all have a lot of software', and there is a portion of my foundation that's involved in that, including getting computers into various libraries and making sure that teacher training programs are very strong. But over 60% of what we do is in world health area. And that's because I think it's far more basic. In fact whenever the computer industry has a panel about the digital divide and I'm on the panel, I always think: OK, you want to send computers to Africa, what about food, and electricity, those computers aren't going to be that valuable, if you don't do those things. It's a little bit like being a troublemaker, they want to sit on the panel and talk about how the computers will solve all the world's problems. They're amazing in what they can do, but they have to be put into perspective of human values. And certainly as a father of two children, thinking about the medicines I take for granted that are not available elsewhere, that sort of rises to the top of the list.

It's been fascinating to me, the doctors and people who have devoted their lives to this area of world health. The people at the foundation, I'm always saying to them, send me books about these topics, give me a chance to meet some of the people who have this passion, and it was really through those meetings that a lot of the priorities that we have come up with were set. On this, the vacation I'm on, you'll be pleased to know I have 14 books on world health and I consider that relaxing. Last night it was The Evolution of Infectious Diseases, a real thriller, if you're into these things!

Well, the big priority in our global health activity is vaccines. Vaccines are sort of miracle drugs in that, for very, very low cost, they can save millions and millions of lives. And in the 1960s and 1970s there was a push to get a program called EPI - it's some basic vaccines - out to the world at large. And that was really a fantastic thing. There was quite a bit of coverage, about 70% coverage achieved and so today vaccines save 3 million children a year that would not be saved if those vaccines weren't given. Now the percentage of the world's health spending that goes on that is less than 1%. In fact there's a simple statistic: that 90% of the world's spending on health goes to the richest 10% and 10% of the spending goes to the other 90%. And so it's a fairly interesting rule in terms of how the money is allocated. So we save the 3 million lives, the 3 million lives per year are being saved. But we're still nowhere near where we should be. In fact an additional 4 million a year could be saved if we took the vaccines we have today and made them available, the ones that you have here and in other developed countries, if those were available everywhere in the world.

And that's pretty dramatic, I remember being on my first panel talking about this and saying 'how can we articulate this?' I mean, I know how to get people excited about software but this number is almost mind-numbing. Millions of children. You could almost get up and say you know we come here to save a child's life. And I could put up a picture and we could all say 'hey, let's save that child's life.' That's one child or ten children or a hundred children or a thousand, ten thousand, a hundred thousand. A million's a lot. And we're talking about many millions. And it's almost hard to relate to, it's such a large scale. It's almost better to go out and visit these countries and meet mothers who have lost children and see it in a very graphic way. But it's a real statistic, there are millions of children who essentially die unnecessarily and both by taking the vaccines we have in getting them out there broadly and in by putting money into new vaccines we can change this quite dramatically.

You might ask why aren't these vaccines being developed. Well as one of the biggest believers in capitalism I'll say that it works very, very well on most things. One thing that it doesn't work well on is if you have diseases that only exist in countries that are very poor. There isn't really incentive for these wonderful drug companies, either the new biotechs or the existing pharmaceutical companies, to focus on these problems. And so it's a case where you almost say you have a market failure. You want to have an incentive for those companies to develop these new drugs – they're the ones who know this work. You don't want governments to step in and have to fund it but you want those incentives to be there.

Often when people approach this area they come in with an approach that's a little bit counterproductive. They say to the companies that already have vaccines 'make those vaccines cheaper,' but if that's all you do then you're also sending them a message about how much they ought to devote to creating vaccines and so we have to break this paradox. And one way to break this paradox is by having funded money that is devoted to buying vaccines so people know that if they come up with a good vaccine that's competitive the money will be there even for the poorest countries so they can go ahead and take a risk. So this idea of a fund that's guaranteed to buy, can help break the cycle.

The overall story in world health is mostly a positive story but there are a few notable exceptions to that. What's going on with AIDS and tuberculosis today is a worsening situation, particularly with AIDS. And this is a case where the balance of money was actually allocated to a treatment. It's great to have a treatment for the people in the developed world who've got the disease and wonderful breakthroughs were made there, partly because there was a market. Very little money was devoted until quite recently to a vaccine for AIDS, and yet that is really the only real hope for the people who have it, the people in the developing countries which is where over 90% of those AIDS infections are taking place. And so a lot has to be done there and that effort has just started. No one knows how long it will take but certainly every dollar that's put in accelerates the date at which we'll have a vaccine and deal with the fact that the three top killers, AIDS, tuberculosis and malaria, are killing over 5 million people a year and that really shouldn't be necessary.

This Global Fund for Children's Vaccines has been created as a vehicle to get the funds in place to help out these poor countries. Melinda and I made an initial commitment of US$750 million to the fund, in the goal to get it up to US$4 billion. That should be possible. What that would do is generate enough income every year to buy vaccine for the 60 poorest counties. So the people involved in that have been going around the world speaking to various governments primarily but also philanthropists and so far, as Gus mentioned, Norway has made a fantastic contribution, the United Kingdom, and we're expecting Japan and Canada and the US to follow fairly soon. The United States is not quite at the level that we'd like, but every bit helps.

This is a case that requires leadership. Leadership to articulate the fact that the billion richest people in this world, if they gave basically about $20 a year to this cause, that the health standards could be largely equalized between the rich and poor world. Very few countries achieve that level today. Some of the Nordic countries, the Netherlands are probably the ones who are a little bit above it, and most are not quite at that level, and so there's a lot to be done here.

There's some new approaches that are really required. We need to strengthen the WHO, the world institution that really has this charter. There are very great people there but there's a lot that could be done to make it an even more effective organization. I'm heading off to India after a stop in Malaysia tomorrow. One of the things that I'll get to do when I'm up in India is actually give polio vaccine. They sent me some vaccine to practice so I'll be doing that tonight on the plane, there'll be people there with cameras and I'm sure if I do it wrong you'll be reading about it on the front page of the newspaper.

This is very exciting cause because polio is very close to being wiped out. There has been a big focus here, the people from Rotary were the biggest backers of this and because we're on the final stretch, just a little effort in the next few years can really make the difference, we can have certification that we are polio-free probably sometime in the next 2-3 years.

That's the second disease, that will be the second disease after smallpox that was mentioned, that's been completely eradicated. Now with many of these diseases there are reasons why eradication's not, should not, be the goal because it's not realistic. In fact, the world embarked on the idea of eradicating malaria very naively, not really understanding how it's spread or the science of it and for many years there was a lot of cynicism about these disease programs because goals had been set that could not be achieved. That's one thing that the community is trying to be a lot more careful about: really making promises that can be met, thinking about eradication programs and the new research programs and having the message be very, very strong there.

So I'm involved in this because I'm fascinated by it. I think it's very important. I've met as many interesting and smart people in this field as I have in the world of technology and so I'm looking forward to the years ahead as I get to learn more and help out more. The impact here is very dramatic. I'll just close by giving my thanks to all of you who are involved in this kind of philanthropy because I think it's incredible.

Thank you.