2005 Borderless Giving

March 15, 2005
Prepared remarks by William H. Gates Sr., co-chair

I want to start by thanking the Global Philanthropy Forum for its leadership and for focusing so much attention on the Millennium Development Goals. It’s a remarkable feat to bring together so many distinguished NGOs, academics, and donors under one roof.

It’s an honor to be here today on behalf of the Bill & Melinda Gates Foundation.

It’s also something of a surprise.

When my son was growing up, I never dreamed that the argumentative little boy who was eating my food and using my name would be my future employer. In fact, just ten years ago, I was planning to retire from my law practice and spend my time entertaining grandkids.

That all changed the day Bill sent me an article about the number of people in the world— especially children—who still die from diseases that we think of as long ago eliminated in this country. The note attached to the article said, “Dad, maybe we can do something about this.”

Until that moment, my retirement plans did not include travel to places like Mozambique, Haiti, or Bangladesh. And I had no thought whatsoever of a second career.

But life presents us with unexpected opportunities, and as a result, I have officially flunked retirement.

Today I’d like to share with you a bit about what we’ve learned in the past few years at the foundation, and give you a sense of the new challenges we’re taking on.

I know I don’t have to tell this group that the challenges we face around the world are enormous. Nor do I have to tell this group that these problems can be solved.

But I do hope to give you a sense of how we think they can be solved.

For us, it all begins with a goal – knowing where you’re going, and why.

Bill and Melinda started their foundation on the basic premise that every human life is just as important as every other. The random geography of a child’s birth should not determine whether she has a chance to lead a healthy life or get a good education.

But that’s exactly the hand that is dealt to millions of people around the world. For instance, in 2000, measles killed more than three-quarters of a million children, most of them in developing countries – because they hadn’t received a one-time vaccine that costs just 25 cents.

Here in the United States, the luck of the draw can decide whether you’re going to get a good education. If you are an African-American or Hispanic ninth grader today, the odds that you’ll graduate from high school are barely 50-50. The odds that you’ll be ready for college are about one in four.

Bill and Melinda believe that it’s simply wrong to allow so many people to die of preventable diseases, or to deny so many young people a decent education, because they weren’t fortunate enough to be born into a prosperous home.

Now, I don’t want to imply that we are, in any way, unique in this belief. I know that every one of you in this room feels exactly the same way.

But I mention this idea because it helped us focus the foundation’s work on a fundamental goal: giving all people, no matter where they live, the chance to lead healthy, productive lives.

And we are dedicated to improving health around the world.

The huge health gap between wealthy and developing nations is simply devastating. The average life expectancy in developing countries is 30 years lower than in the industrialized world. Thirty years.

Why? We believe there are two basic reasons – and these two facts represent the two biggest challenges in global health.

First, many people in developing countries don’t have access to basic health interventions, such as vaccines, that you and I take for granted.

And second, only a tiny fraction of the research and development in the field of health goes toward solving the problems that cause most of the illness and death in developing countries.

It’s easy to see why. The private sector generally is not developing or delivering medicines for poor countries because poor countries can’t buy them. And wealthy governments are not fighting these diseases because the wealthy world doesn’t have them.

At the Gates Foundation, we believe that the best way we can help change the situation is to make high-risk investments that have the possibility of leading to health solutions, and then help make sure that those solutions reach the people who need them the most.

We support the scientific work that leads to important discoveries—say, a new drug for malaria—and see that these discoveries are tested and developed. Then we work to make sure that there are systems in place to adopt these new tools as they become available.

We’re applying this strategy in a number of areas.

First, when it comes to global health, every conversation has to start with HIV/AIDS.

There are some 39 million people in the world infected with this horrible disease, nearly all of them in the developing world. About 13,000 new cases occur every day.

We cannot sit by while some 3 million people who are already infected die of AIDS every year. They deserve access to treatment.

In Botswana, which has the highest HIV infection rate in the world, we are part of a promising partnership with the Merck pharmaceutical company and the government of Botswana. This partnership has provided treatment to more than 17,000 patients so far.

We are also working hard to slow the spread of AIDS. In India, for instance, the disease has not yet reached the general population, but it has taken root in particular areas – and could reach epidemic proportions very soon.

One way we can prevent that is by combating ignorance and spreading reliable information about health.

Last year I had the privilege of seeing one program in India that does this very effectively. It was based at a huge truck terminal called Cotton Green, on the outskirts of Mumbai.

You might be wondering: “What do truckers have to do with AIDS?”

We have found that truckers are an important link in the HIV chain, because many of them have multiple sex partners along their delivery routes, and too few of them use condoms.

So they are one of the populations that is acquiring and spreading HIV—often to their innocent wives when they return home.

Around Cotton Green there’s a kind of fairground, where performers put on shows and skits while the truckers wait for their cargo. But they’re not performing for spare change – they’re performing a public service. These skits are all about preventing HIV.

I saw one ventriloquist who performed with a little monkey puppet. He had a great line that always seemed to get a laugh. He’d ask the monkey if he knew how to prevent AIDS.

And the monkey would reply: “Why, even a monkey knows you should use a condom to prevent AIDS!”

We need much more HIV education like that happening at Cotton Green if we’re going to slow the spread of HIV.

But we aren’t just fighting ignorance, we must also take on its close cousin: stigma.

Stigma is a remarkably powerful force. In some countries, healthy people won’t even touch someone with AIDS. People are afraid to get tested – because if they test positive, they’ll be kicked out of their homes, even banished from their communities. Reducing stigma is an absolute must in the fight against HIV.

Our foundation also supports programs that deliver proven prevention tools – like condoms; campaigns to reduce risky behavior; and treatment for sexually transmitted diseases. We know that these tools work, because we’ve seen it happen.

In Thailand, new HIV cases dropped 80 percent in the 1990s, partly because the government there has heavily promoted condom use among commercial sex workers.

In fact, government inspectors visit brothels, posing as would-be clients, and the brothels that don’t enforce rules about condoms can be shut down.

But current prevention efforts only go so far – which is why we need to encourage research into new forms of prevention.

There has been a lot of promising work in this area. One example is a microbicide – a gel or cream that a woman could apply before sex, without her partner’s knowledge – which could help prevent the spread of HIV and other diseases.

These microbicides are still in development, but one day they could put the power of prevention into the hands of women around the world.

Ultimately, though, we believe that the best long-term hope to stop AIDS is an effective HIV vaccine.

Unfortunately, developing such a vaccine is a complicated, expensive, and slow process.

Many brilliant scientists are devoting their lives to this effort. But it’s hard for them to collaborate and share information, which in turn means that the most promising approaches aren’t always prioritized.

That’s why the foundation is a major supporter of the Global HIV Vaccine Enterprise – a project that is helping to coordinate the worldwide search for a vaccine.

This alliance has brought together international leaders from commercial, academic, and research institutions to tackle major hurdles in HIV vaccine research.

There won’t be an HIV vaccine next year, or the year after that. But when it finally arrives, it will be a great moment in our history—a great moment for the researchers, caregivers, humanitarian groups, and governments who have been so dedicated to this fight.

Thankfully, many other diseases can be prevented with vaccines right now.

A good part of the superior health that we in the wealthy world enjoy is a direct result of vaccinations, which are almost universally administered to our children at a very young age.

But far too few of these vaccines reach the developing world. All told, each year between 2 and 3 million children die because they don’t get access to vaccines that are widely available in wealthy countries.

But there is hope. Organizations around the world have made tremendous progress on this problem – both in making sure that current vaccines reach the people who need them, and in developing new vaccines.

Thanks to a very successful public-private partnership called the Global Alliance for Vaccines and Immunizations (GAVI), more than 35 million children have been vaccinated against diseases like hepatitis B and yellow fever.

Watching GAVI take shape is one of the most gratifying experiences I’ve had at the foundation.

I remember the night several years ago when the idea for this organization first took hold. A group of people who had dedicated their careers to providing vaccines in poor countries were having dinner at my son’s house.

They were talking about how earlier vaccination efforts had petered out, mostly because they didn’t have the funds they needed.

Bill felt a strong desire to contribute to their work, and as the group continued to talk about what they might do, he said:
“Be sure and think big.”

I think that was the first time anyone had said something like that to them.

GAVI went on to bring together foundations, ministers of health, and pharmaceutical companies to solve a seemingly intractable problem. Six years later, GAVI has helped save more than half a million lives in 70 countries.

I can’t think of a more powerful example of how public-private partnerships can change the lives of millions of people. Bill and Melinda agree: They consider GAVI the best investment they have ever made. And to prove it, they recently committed to supporting GAVI’s work for 10 more years.

Vaccines have had a profound, direct effect on the lives of children by protecting them against crippling diseases. But we can also protect children indirectly – by helping their mothers stay healthy.

Each year, more than half a million women, most of them in developing countries, die from complications in pregnancy or childbirth.

Meeting the need for contraceptive services in developing countries would prevent 52 million unintended pregnancies each year, which in turn would prevent 500,000 children from losing their mothers.

Many more lose their mothers to devastating diseases. Here again, we think the foundation’s best role is to encourage the discovery, development, and adoption of tools that can improve women’s lives – and, by extension, their children’s lives.

For instance, one of our grantees, Health Alliance International, is working on a rapid test for syphilis that can be performed by minimally trained health workers.

Syphilis increases a woman’s risk of contracting HIV, causes mental illness, and greatly increases her chances of having a stillborn child.

Health Alliance International is testing this technology in Mozambique, where 15 percent of women are infected with the disease.

After drawing a drop of blood from a woman’s finger, the birth attendant can run a simple test – akin to a pregnancy test – and know within 15 minutes if she has syphilis.

If so, she can be treated on the spot with a 25-cent shot of penicillin, which can cure the mother and protect her unborn child. Amazing.

So that gives you a sense of what we do and why we do it. Which leaves the question of “how?”:

How do we decide which issues to work on and which programs to support?

And how do we know what our role is, and what we hope others will do?

We strongly believe in the power of change agents. We have seen over and over again what individuals can do to effect change.

You have all heard the wise words of Margaret Mead, who said: “Never underestimate the ability of a small group of committed individuals to change the world. In fact, that’s the only thing that ever has.”

We also believe it’s our role to make big bets. We can afford to take the kinds of calculated risks that may be difficult for governments and private industry.

That’s why we’re investing in the development of an AIDS vaccine. No one is sure when we will have one. But as I said before, when we do, it will change the world.

Most of our big bets are focused on prevention. Although we recognize the importance of treating problems, we think that the ultimate solution relies on getting to the source of the problem.

Talking about prevention always makes me think of that old story about the village by the river. Some of you probably know this story.

The story goes that one a day three people on a river bank observed a terrifying spectacle—babies were floating down the river.

The first person jumped into the river and was able to rescue one baby. Everybody was ecstatic. The second person jumped in and saved a few more but couldn’t save them all. The third person meanwhile ran up river and to find out who was throwing babies into the river.

Although all those people were doing something important, that third person best describes the role we’re attempting to play—that of getting to the root of a problem and helping prevent disaster.

In the end, there is one last principle that I try to keep in mind, above all the others: never forget who we are trying to help, and why.

Many people are making the case these days that global health is an economic issue and a national security issue.

That’s all right with me. If we have to make that argument to get the public funds we need to fight disease, we should do it.

But to me, disease is not primarily an economic issue or a national security issue; it is a humanitarian issue. People are dying, and we can save them; and that ought to be enough.

People suffering from poverty and disease are human beings.

They are not national security assets. They are not markets for our exports. They are not allies in the war against terrorism.

They are human beings who have infinite worth in their own right without any reference to us.

They have mothers who love them, children who need them, and friends who cherish them–and we simply ought to help them.

Thank you.