2002 Retroviruses Conference
February 24, 2002
Remarks by Bill Gates, co-chair
Remarks by Bill Gates, co-chair
Well, good evening. It's certainly hard to follow Andrew, who I agree with completely. I've never spoken at a medical research conference before, not on retroviruses or any other subject, but I'm here because I think the work you do is incredibly important and that was articulated very well in those photos.
My normal job is one of working on information technology, breakthrough software, and that's a very exciting area. It's one where there are certain miracle technologies, so-called Moore's Law, which is a prediction that talks about the doubling in power of chips every couple of years. And what that's meant for computing is that it's now more than a million times cheaper than it was 20 years ago.
There are other miracles in this area, things like advances in optic fiber, things like advances in storage capacity. The exponential improvement that you see in chip performance is actually exceeded by the advances in storage and optic fiber speed. And the goal in these areas is a goal of empowerment, giving people better and better tools to share knowledge and work together, and we're on the frontier of some very exciting things.
This decade alone we'll see more advance than we've seen in the history of computing. Just in the next few years we'll have things like a tablet device that you can carry with you and take notes, more readable than even paper, connected through wireless networks and very easy to use compared to what we have today.
So it's a very exciting field and I often feel that that work would be justified even if its only application was in the field of education or even if its only application was providing tools to people like yourselves in order to accelerate the progress that is taking place in the world of medicine.
One interesting priority that we have is dealing with computer viruses. It's a very tough problem and the analogies to the world of medicine are quite strong. In fact, some of our recent advances have to do with putting out-called digital sentinels, that is systems that we allow to be infected, that we have a comprehensive way of looking at the state of those systems. We actually have incredible variety in those systems in terms of how they look at differences, mirroring some genetic variety as well, so a very interesting area.
So how did I get interested in medicine? Well, it's a bit of a circuitous path. I started out poorly because my biology teacher in high school made biology very uninteresting. I didn't like dissecting frogs or test tubes; it all seemed too hands-on from my point of view.
So then about six or seven years ago, I was thinking about philanthropy and what the priorities would be and were there areas in science that needed to be funded, were there areas in terms of access to technology, making sure people had computers and that they were connecting things up, and as I looked at it I thought about human priorities and decided that health was probably the thing of greatest importance and that issues relating to population growth probably were the ones that would have the most dramatic effect in terms of making sure that resources in all dimensions -- the environment, education, healthcare -- that if you can reduce population growth, if you can stabilize it, that that would be the most effective.
And so the early work of the Gates Foundation was mostly in the area of making sure people had access to information on family size and what their options were there.
And because of that involvement I got to know people who worked in world health. One of the documents that I still remember and struck me pretty dramatically was the world development report in 1993, sponsored by the World Bank. It actually for the first time, or for the first time I saw it really went through and comprehensively chronicled how different health conditions in the world at large are from conditions in the rich countries, particularly the United States.
And it was very striking to me, because they took, as the World Bank should, a fairly numeric approach, but every page screamed out that human life was not being treated as being nearly as valuable in the world at large as it should be.
So through that reading I had a chance to say, you know, "I've got to meet more people in this field," and the two things that really emerged as priorities are work in vaccination and work in AIDS, certainly including the intersection of those two -- a vaccine for AIDS.
I remember one dinner after we've given our first $150 million grant for vaccines where I said to the people who had largely come to be nice, I said, "Well, what could you do with more," and that kind of opened the dinner up. They decided they'd stay later if I was going to ask that kind of a question. (Laughter.) And, of course, they all had areas that they were working in and very passionate about, particularly a number of the people involved in AIDS.
And so the primary focus of the foundation is world health. Vaccines has been a very important thing, both funding the creation of new vaccines and making sure that some of the vaccines that we take for granted -- Hepatitis B, HIV, hopefully rotavirus and a few others in the near future -- that these vaccines get out to the world at large fairly rapidly. Typically there's been a 15 to 20-year lag between the use of a new vaccine in the rich world and the poor world.
Unfortunately, many of the needs of the world at large are not present in rich countries. So here we get what you'd have to call the greatest market failure of all time, things like Meningitis A simply isn't present enough for the work to be done, and yet the science is there and through the application of about, $60 million, including everything, really the factory, the trials, things of that nature, a form of Meningitis that kills hundreds of thousands will receive a vaccine that should make it a thing of history.
I have to say that as I've gone through learning about infectious diseases there is a cycle you go through; you learn more, which is disappointing to know about the various parasitic diseases and things that don't get attention, and then you go through the cycle of saying, "Okay, there are people doing something about this and it's possible to help with those things." And I'm generally an optimist, so I focus more on the latter part, which is that some great things can be done.
Some diseases -- trachoma, schistosomiasis -- actually the drugs exist; it's merely a matter of getting them out there, and they're having progress on a number of things.
So I still find myself surprised at the basic framework, the 90/10 rule: 90 percent of the world's resources are spent on 10 percent of its medical problems and conversely 10 percent of the resources are spent on 90 percent of the problem.
In the area of AIDS the relative priority of work on a vaccine is certainly something that I'm enthused to see that increasing. There we have duality of dwelling, "Couldn't more have been done?" But much more on the positive side saying, "There is more being done" and the trend is very good to get the resources to move those things forward.
It is daunting to learn about the complexities of going through the trials and looking at some of the processes it's really more designed for rich world conditions than something that's not of the horrific crisis nature that AIDS and some of these other situations are.
And even something like tuberculosis, I kind of have to say to people, well, when was the last vaccine for tuberculosis invented and how much is known about its efficacy and could it be improved, and things like that. And it seems like a very good specific of the market failure to have a vaccine that's really from the '20s and that in the current procedures a vaccine like that really it would be very tough to move one forward and including one like that one.
So there is certainly a lot to be learned. The foundation, as was mentioned in the introduction, is trying to support various activities around AIDS as much as we can. We've been very lucky in terms of building up a small but very effective staff. We have Helene Gayle now who's in charge of our different AIDS activities, and I'm very enthused about the partnerships we have and the things that are going on.
In the area of education, having people know that they do have behavioral choices. Certainly the example of Thailand is the one that people hold up and say, "Could that be repeated in other places?" Well, it's tougher in other locations, but I believe that in countries of low prevalence it's certainly a huge priority to do those things. Education in high prevalence countries is equally important.
A number of us get a chance to travel around and see these things. Next month my dad, who has the same name as I do, and President Carter will be out in South Africa and Kenya and Nigeria doing everything they can to raise the visibility of what's going on.
Some anecdotes really just stun me; for example, I'm told that in South Africa death certificates never mention AIDS and that the visibility of it as something that affects everyone simply isn't there despite the situation that exists today.
Nigeria, there are tough conditions there but catching things a little earlier on and hopefully with the right political support, the right encouragement things can be done in an even better way.
Some things we're doing are at an early stage, the work in Botswana to take a government that appears to be very committed to changing things and on a per capita basis giving them the resources to engage in a wide range of things including anti-retroviral treatment for the population that's there and see how can that infrastructure be put in place, supporting the Elizabeth Glaser Foundation in terms of the maternal transmission efforts; there's certainly a lot that can come out of that.
I think a microbicide it's a particular priority for us, because of the optimism that can say in less than five years a very effective microbicide could actually be out and the value of that prevention when you're dealing with the exponential nature of an epidemic, the value of that prevention could be quite incredible.
Just a few weeks ago we announced support for a phase tree trial of Carraguard and hopefully we'll be able to support three or four other compounds going into phase three trials in order to be able to get out and have an effect as soon as possible.
At this stage people don't even seem to want to do predictions. If you go back to some of the early predictions by Mann and others about what would the AIDS epidemic be like, it's interesting to see that in almost every case the numeric predictions were low of the mark of what would happen in the developing world.
And it's interesting to go back and look at some of the debates about whether phase three trials should be started for various things and see that people at those times were saying, you know, five, six years ago that in only a few years, say a type vaccine would be out in phase three trial.
And so in some ways it's a challenge of the science. The challenge of the epidemics are continually surprising us by how tough they are.
I like to ask people, you know, what is their prediction for a very low prevalence country like India; you know, what is the likely case over the next 20 or 30 years and you get a variation of as much as 100 million, that is worst case to best case efforts that it would vary by 100 million lives or even more.
And that number is a stunning number. As Andrew said, a number like that exceeds all the death through major wars in the last century, and in some ways this is more horrific in terms of what it does to society and the children and the many generations that will be affected.
The vaccine efforts, a lot of our resources there have focused on IAVI and the work that they're doing and it's something I follow very closely, hoping that things end up being very much on the positive end of what's possible.
So what do we think about moving forward? Well, certainly this is a cause that deserves more visibility. It's getting more visibility than it's received in the past, so on a relative basis I think that's a great improvement. But certainly it doesn't have the visibility that's caused political action.
I was at the World Economic Forum a few weeks ago and really pushing to say that particularly now as people are thinking of the world that's very interconnected, thinking about the world at large looks at the United States and the other rich countries and says, you know, do we behave in a way where we're sharing our largesse, our good luck, in an appropriate way back with the entire world.
And a lot of what so-called anti-globalization is about, it's not about saying, "Let's go back to a hundred years ago and the conditions there," but rather it's saying, "As we move forward to have these advances on what basis are those things shared?" And certainly there's an area where the U.S. and others could put their best foot forward and really show how they feel it could be by addressing with action and resources, in a fairly dramatic way, the AIDS health issue and many others.
As I was talking at the World Economic Forum there is a number of other countries that are willing to step up what they give but it's tough for them politically because on really any measure that you use -- per capita, per GDP -- the U.S. is the least generous in some of these areas, so it's very tough for them to go in and say, "Okay, let's get up to .3 percent of GDP if the U.S. is going to stay down at something like .1 percent."
And yet there is certainly a paradox here because anyone who sees what's going on, anyone who would sit and see Andrew's slideshow would certainly say, "Yes, I would like to personally give and have my government get more involved in giving to these activities." And so we have to believe that it's really this lack of visibility that's holding things back.
My analogy is that if we took the world and we resorted the neighborhoods to be in random locations so that most of the neighborhoods that you would live next to would reflect the average living conditions in the world at large, then these problems would get addressed. They'd get addressed on pure humanitarian grounds.
Well, there are a lot of efforts to go around and justify these efforts on other grounds. I have nothing against that but it seems unusual that they have to be justified on economic grounds or military grounds or on any grounds other than the humanitarian issues. Of course, something of this importance is worthy whatever justification that makes sense around it.
I am optimistic about the work that you're all doing. I think the advances in immunology that will come out of the work on AIDS will be fantastic for AIDS and for other disease that come along.
Certainly understanding these different vectors and where they operate in the immune system, understanding what intermediate data points one can use to see what's being effective and what's not effective. You know, it would be wonderful in the fight against malaria and tuberculosis to have these deeper understandings of the basic science that certainly will come out of this work.
I think that there will have to be a level of collaboration to really move these causes forward that hasn't been seen before. After all, when people talk about a solution and it's many parts, you know, what's the vector, what's the payload, what's the adjuvant, what are the different things that are put together, and if it turns out that one packaged solution, that somebody's coming with the work that's great, but it's probably more likely that there will be some mixing and matching of these different elements, which in terms of cooperation will require something new and very important and probably a model for future activities.
I think the collaboration between the rich world and poor world will have to be very different. You know, the ideal would be to have a cohort of, say, over 20,000 people, say, sex workers in a country where the epidemic is growing where you have conversion rates of over 20 percent a year. If a poor country like an India or someone had that cohort and all the different science, the different variations and mixing and matching could be applied very effectively in a group like that, it would shorten by years the amount of time before a real vaccine solution was available.
And people should have pretty clearly in mind what it means to delay a year. I talk to some who are very optimistic about these things. I have no great prediction myself, except my normal optimism. But I definitely believe some of the systems that would allow these things to move faster require collaboration at a level that's never seen before.
So I am here speaking in a medical research conference because your work is so important. I congratulate you on all the progress that's been made. I exhort you to make dramatically more progress and I'm excited to be involved and together with everyone in the foundation help in any way that we can.
Thank you.
(Applause.)
My normal job is one of working on information technology, breakthrough software, and that's a very exciting area. It's one where there are certain miracle technologies, so-called Moore's Law, which is a prediction that talks about the doubling in power of chips every couple of years. And what that's meant for computing is that it's now more than a million times cheaper than it was 20 years ago.
There are other miracles in this area, things like advances in optic fiber, things like advances in storage capacity. The exponential improvement that you see in chip performance is actually exceeded by the advances in storage and optic fiber speed. And the goal in these areas is a goal of empowerment, giving people better and better tools to share knowledge and work together, and we're on the frontier of some very exciting things.
This decade alone we'll see more advance than we've seen in the history of computing. Just in the next few years we'll have things like a tablet device that you can carry with you and take notes, more readable than even paper, connected through wireless networks and very easy to use compared to what we have today.
So it's a very exciting field and I often feel that that work would be justified even if its only application was in the field of education or even if its only application was providing tools to people like yourselves in order to accelerate the progress that is taking place in the world of medicine.
One interesting priority that we have is dealing with computer viruses. It's a very tough problem and the analogies to the world of medicine are quite strong. In fact, some of our recent advances have to do with putting out-called digital sentinels, that is systems that we allow to be infected, that we have a comprehensive way of looking at the state of those systems. We actually have incredible variety in those systems in terms of how they look at differences, mirroring some genetic variety as well, so a very interesting area.
So how did I get interested in medicine? Well, it's a bit of a circuitous path. I started out poorly because my biology teacher in high school made biology very uninteresting. I didn't like dissecting frogs or test tubes; it all seemed too hands-on from my point of view.
So then about six or seven years ago, I was thinking about philanthropy and what the priorities would be and were there areas in science that needed to be funded, were there areas in terms of access to technology, making sure people had computers and that they were connecting things up, and as I looked at it I thought about human priorities and decided that health was probably the thing of greatest importance and that issues relating to population growth probably were the ones that would have the most dramatic effect in terms of making sure that resources in all dimensions -- the environment, education, healthcare -- that if you can reduce population growth, if you can stabilize it, that that would be the most effective.
And so the early work of the Gates Foundation was mostly in the area of making sure people had access to information on family size and what their options were there.
And because of that involvement I got to know people who worked in world health. One of the documents that I still remember and struck me pretty dramatically was the world development report in 1993, sponsored by the World Bank. It actually for the first time, or for the first time I saw it really went through and comprehensively chronicled how different health conditions in the world at large are from conditions in the rich countries, particularly the United States.
And it was very striking to me, because they took, as the World Bank should, a fairly numeric approach, but every page screamed out that human life was not being treated as being nearly as valuable in the world at large as it should be.
So through that reading I had a chance to say, you know, "I've got to meet more people in this field," and the two things that really emerged as priorities are work in vaccination and work in AIDS, certainly including the intersection of those two -- a vaccine for AIDS.
I remember one dinner after we've given our first $150 million grant for vaccines where I said to the people who had largely come to be nice, I said, "Well, what could you do with more," and that kind of opened the dinner up. They decided they'd stay later if I was going to ask that kind of a question. (Laughter.) And, of course, they all had areas that they were working in and very passionate about, particularly a number of the people involved in AIDS.
And so the primary focus of the foundation is world health. Vaccines has been a very important thing, both funding the creation of new vaccines and making sure that some of the vaccines that we take for granted -- Hepatitis B, HIV, hopefully rotavirus and a few others in the near future -- that these vaccines get out to the world at large fairly rapidly. Typically there's been a 15 to 20-year lag between the use of a new vaccine in the rich world and the poor world.
Unfortunately, many of the needs of the world at large are not present in rich countries. So here we get what you'd have to call the greatest market failure of all time, things like Meningitis A simply isn't present enough for the work to be done, and yet the science is there and through the application of about, $60 million, including everything, really the factory, the trials, things of that nature, a form of Meningitis that kills hundreds of thousands will receive a vaccine that should make it a thing of history.
I have to say that as I've gone through learning about infectious diseases there is a cycle you go through; you learn more, which is disappointing to know about the various parasitic diseases and things that don't get attention, and then you go through the cycle of saying, "Okay, there are people doing something about this and it's possible to help with those things." And I'm generally an optimist, so I focus more on the latter part, which is that some great things can be done.
Some diseases -- trachoma, schistosomiasis -- actually the drugs exist; it's merely a matter of getting them out there, and they're having progress on a number of things.
So I still find myself surprised at the basic framework, the 90/10 rule: 90 percent of the world's resources are spent on 10 percent of its medical problems and conversely 10 percent of the resources are spent on 90 percent of the problem.
In the area of AIDS the relative priority of work on a vaccine is certainly something that I'm enthused to see that increasing. There we have duality of dwelling, "Couldn't more have been done?" But much more on the positive side saying, "There is more being done" and the trend is very good to get the resources to move those things forward.
It is daunting to learn about the complexities of going through the trials and looking at some of the processes it's really more designed for rich world conditions than something that's not of the horrific crisis nature that AIDS and some of these other situations are.
And even something like tuberculosis, I kind of have to say to people, well, when was the last vaccine for tuberculosis invented and how much is known about its efficacy and could it be improved, and things like that. And it seems like a very good specific of the market failure to have a vaccine that's really from the '20s and that in the current procedures a vaccine like that really it would be very tough to move one forward and including one like that one.
So there is certainly a lot to be learned. The foundation, as was mentioned in the introduction, is trying to support various activities around AIDS as much as we can. We've been very lucky in terms of building up a small but very effective staff. We have Helene Gayle now who's in charge of our different AIDS activities, and I'm very enthused about the partnerships we have and the things that are going on.
In the area of education, having people know that they do have behavioral choices. Certainly the example of Thailand is the one that people hold up and say, "Could that be repeated in other places?" Well, it's tougher in other locations, but I believe that in countries of low prevalence it's certainly a huge priority to do those things. Education in high prevalence countries is equally important.
A number of us get a chance to travel around and see these things. Next month my dad, who has the same name as I do, and President Carter will be out in South Africa and Kenya and Nigeria doing everything they can to raise the visibility of what's going on.
Some anecdotes really just stun me; for example, I'm told that in South Africa death certificates never mention AIDS and that the visibility of it as something that affects everyone simply isn't there despite the situation that exists today.
Nigeria, there are tough conditions there but catching things a little earlier on and hopefully with the right political support, the right encouragement things can be done in an even better way.
Some things we're doing are at an early stage, the work in Botswana to take a government that appears to be very committed to changing things and on a per capita basis giving them the resources to engage in a wide range of things including anti-retroviral treatment for the population that's there and see how can that infrastructure be put in place, supporting the Elizabeth Glaser Foundation in terms of the maternal transmission efforts; there's certainly a lot that can come out of that.
I think a microbicide it's a particular priority for us, because of the optimism that can say in less than five years a very effective microbicide could actually be out and the value of that prevention when you're dealing with the exponential nature of an epidemic, the value of that prevention could be quite incredible.
Just a few weeks ago we announced support for a phase tree trial of Carraguard and hopefully we'll be able to support three or four other compounds going into phase three trials in order to be able to get out and have an effect as soon as possible.
At this stage people don't even seem to want to do predictions. If you go back to some of the early predictions by Mann and others about what would the AIDS epidemic be like, it's interesting to see that in almost every case the numeric predictions were low of the mark of what would happen in the developing world.
And it's interesting to go back and look at some of the debates about whether phase three trials should be started for various things and see that people at those times were saying, you know, five, six years ago that in only a few years, say a type vaccine would be out in phase three trial.
And so in some ways it's a challenge of the science. The challenge of the epidemics are continually surprising us by how tough they are.
I like to ask people, you know, what is their prediction for a very low prevalence country like India; you know, what is the likely case over the next 20 or 30 years and you get a variation of as much as 100 million, that is worst case to best case efforts that it would vary by 100 million lives or even more.
And that number is a stunning number. As Andrew said, a number like that exceeds all the death through major wars in the last century, and in some ways this is more horrific in terms of what it does to society and the children and the many generations that will be affected.
The vaccine efforts, a lot of our resources there have focused on IAVI and the work that they're doing and it's something I follow very closely, hoping that things end up being very much on the positive end of what's possible.
So what do we think about moving forward? Well, certainly this is a cause that deserves more visibility. It's getting more visibility than it's received in the past, so on a relative basis I think that's a great improvement. But certainly it doesn't have the visibility that's caused political action.
I was at the World Economic Forum a few weeks ago and really pushing to say that particularly now as people are thinking of the world that's very interconnected, thinking about the world at large looks at the United States and the other rich countries and says, you know, do we behave in a way where we're sharing our largesse, our good luck, in an appropriate way back with the entire world.
And a lot of what so-called anti-globalization is about, it's not about saying, "Let's go back to a hundred years ago and the conditions there," but rather it's saying, "As we move forward to have these advances on what basis are those things shared?" And certainly there's an area where the U.S. and others could put their best foot forward and really show how they feel it could be by addressing with action and resources, in a fairly dramatic way, the AIDS health issue and many others.
As I was talking at the World Economic Forum there is a number of other countries that are willing to step up what they give but it's tough for them politically because on really any measure that you use -- per capita, per GDP -- the U.S. is the least generous in some of these areas, so it's very tough for them to go in and say, "Okay, let's get up to .3 percent of GDP if the U.S. is going to stay down at something like .1 percent."
And yet there is certainly a paradox here because anyone who sees what's going on, anyone who would sit and see Andrew's slideshow would certainly say, "Yes, I would like to personally give and have my government get more involved in giving to these activities." And so we have to believe that it's really this lack of visibility that's holding things back.
My analogy is that if we took the world and we resorted the neighborhoods to be in random locations so that most of the neighborhoods that you would live next to would reflect the average living conditions in the world at large, then these problems would get addressed. They'd get addressed on pure humanitarian grounds.
Well, there are a lot of efforts to go around and justify these efforts on other grounds. I have nothing against that but it seems unusual that they have to be justified on economic grounds or military grounds or on any grounds other than the humanitarian issues. Of course, something of this importance is worthy whatever justification that makes sense around it.
I am optimistic about the work that you're all doing. I think the advances in immunology that will come out of the work on AIDS will be fantastic for AIDS and for other disease that come along.
Certainly understanding these different vectors and where they operate in the immune system, understanding what intermediate data points one can use to see what's being effective and what's not effective. You know, it would be wonderful in the fight against malaria and tuberculosis to have these deeper understandings of the basic science that certainly will come out of this work.
I think that there will have to be a level of collaboration to really move these causes forward that hasn't been seen before. After all, when people talk about a solution and it's many parts, you know, what's the vector, what's the payload, what's the adjuvant, what are the different things that are put together, and if it turns out that one packaged solution, that somebody's coming with the work that's great, but it's probably more likely that there will be some mixing and matching of these different elements, which in terms of cooperation will require something new and very important and probably a model for future activities.
I think the collaboration between the rich world and poor world will have to be very different. You know, the ideal would be to have a cohort of, say, over 20,000 people, say, sex workers in a country where the epidemic is growing where you have conversion rates of over 20 percent a year. If a poor country like an India or someone had that cohort and all the different science, the different variations and mixing and matching could be applied very effectively in a group like that, it would shorten by years the amount of time before a real vaccine solution was available.
And people should have pretty clearly in mind what it means to delay a year. I talk to some who are very optimistic about these things. I have no great prediction myself, except my normal optimism. But I definitely believe some of the systems that would allow these things to move faster require collaboration at a level that's never seen before.
So I am here speaking in a medical research conference because your work is so important. I congratulate you on all the progress that's been made. I exhort you to make dramatically more progress and I'm excited to be involved and together with everyone in the foundation help in any way that we can.
Thank you.
(Applause.)
Sign up for The Optimist newsletter
Subscribe to The Optimist to get weekly updates on the latest in global health, gender equality, education, and more.