Please note that this is an unedited transcript,
so it doesn't flow as well as an article. But
it's an incredibly interesting read.
Note also that this interview was done in 2003,
but is an interesting insight into Gates' thinking in this area.
Udhay
http://www.pbs.org/now/transcript/transcript_gates.html
5.09.03
Science and Health
Transcript: Bill Moyers Interviews Bill Gates
Transcript
MOYERS: When I first heard that you were going to
give away billions of dollars to, global health I
was skeptical. I mean, no one can doubt that you
know everything there is to know about
information technology, but global health? And I
thought, here's a man surrounded by power and
privilege whose every need and every comfort are
met. How could he possibly see the world through
the eyes of an impoverished woman with HIV in
India or a hungry, starving child in Mozambique?
How could he possibly get inside of their way of
seeing the world so that what he did wasn't just a rich man's hobby?
GATES: Certainly I'll never be able to put myself
in the situation that people growing up in the
less developed countries are in. I've gotten a
bit of a sense of it by being out there and
meeting people and talking with them. And one of
the gentlemen I met with AIDS talked about how
he'd been kicked out of where he'd lived and how
he felt awful he'd given it to his wife and their
struggle to make sure their child didn't have it,
and the whole stigma thing, which, you know,
that's hard to appreciate. In this country when
you get sick people generally reach out, you
know, that's the time to help other people and
yet some of these diseases it's quite the opposite.
So what I was thinking about was where my
resources that I'm the steward of be able to make
an impact, I thought "okay, what's the greatest
inequity left?" And to me, and the more I learned
about health and the unbelievable inequity, it
kind of stunned me, it shocked me, every step of the way.
MOYERS: You could have chosen any field, any
subject, any issue and poured billions into it
and been celebrated. How did you come to this one? To global health?
GATES: The two areas that are changing in this
amazing way are information technology and
medical technology. Those are the things that the
world will be very different 20 years from now than it is today.
I'm so excited about those advances. And they
actually feed off of each other. The medical
world uses the information tools to do their
work. And so when you have those advances you
think will they be available to everyone. Will
they not just be for the rich world or even just
the rich people and the rich world? Will they be for the world at large?
The one issue that really grabbed me as urgent
were issues related to population
reproductive health.
And maybe the most interesting thing I learned is
this thing that's still surprising when I tell
other people which is that, as you improve health
in a society, population growth goes down.
You know I thought it was
before I learned about
it, I thought it was paradoxical. Well if you
improve health, aren't you just dooming people to
deal with such a lack of resources where they
won't be educated or they won't have enough food?
You know, sort of a Malthusian view of what would take place.
And the fact that health leads parents to decide,
"okay, we don't need to have as many children
because the chance of having the less children
being able to survive to be adults and take care
of us, means we don't have to have 7 or 8 children." Now that was amazing.
MOYERS: But did you come to reproductive issues
as an intellectual, philosophical pursuit? Or was
there something that happened? Did come up on
was there a revelation?
GATES: When I was growing up, my parents were
almost involved in various volunteer things. My
dad was head of Planned Parenthood. And it was
very controversial to be involved with that. And
so it's fascinating. At the dinner table my
parents are very good at sharing the things that
they were doing. And almost treating us like adults, talking about that.
My mom was on the United Way group that decides
how to allocate the money and looks at all the
different charities and makes the very hard
decisions about where that pool of funds is going
to go. So I always knew there was something about
really educating people and giving them choices in terms of family size.
GATES: I have to say I got off the track when I
started Microsoft, I thought okay now I have my,
you know, my passion. At least for the next 40
years or so. And when my mom said to me, "oh you
have to do a United Way campaign," I said to my
mom, "mom this is serious stuff now. That was all
nice to talk about but you know I've got to pay
these people and if we don't get enough
contracts. And this is a very competitive
environment. And so this whole notion that we're
gonna sit around and drink tea and do United Way
campaigns, I don't think we have time for that."
But she kept working on me and saying, "no, this
is a good thing." And had me meet with other people.
So finally I thought, "okay I'll fit it into my
framework" which is getting the employees to kind
of feel more bonded, more of a team. You know,
and appreciate the unique position they're in.
And so we made a United Way Fund. We had contests
around it. We had the agencies come in.
But a little bit I have drifted away from
thinking about these philanthropic things. And it
was only as the wealth got large enough and
Melinda and I had talked about the view that that
wealth wasn't something that would be good to just pass to the children.
Because in a wealth of any kind of magnitude like
that, it's actually more haven't asked tem
their opinion yet but more of a handicap than
it is of a benefit. So you know once you decide
that over 95 percent of it's going back to
society, then you do start talking about where it will go.
And so Melinda and I were having those
conversations. But we only had one or two
projects that we thought we'd get into early. We
thought, okay, this is mostly for many decades from now.
MOYERS: You were clearly competent at making
money. Did you doubt your competence in giving it away?
GATES: I actually thought that it would be a
little confusing during the same period of your
life to be in one meeting when you're trying to
make money, and then go to another meeting where
you're giving it away. I mean is it gonna erode
your ability, you know, to make money? Are you
gonna somehow get confused about what you're trying to do?
MOYERS: It's a nice confusion. It's a very nice confusion.
GATES: So, you know, I didn't want to mix those
two things together. The big milestone event for
me though was
a report was done, it's called
"The World Development Report 1993" that talked
about these diseases. And I remember seeing the
article and it showed that Rotavirus over a half
million children per year. And I said to myself, that can't be true.
You know after all, the newspaper, whenever
there's a plane crashing and 100 people die, they
always report that. How can it be that this
disease is killing a half million a year? I've
never seen an article about it until now. And it
wasn't even an article about that. It was just a
graph that had you know these 12 diseases that
kill, most of which I had never heard of.
And so I thought, this is bizarre. Why isn't it
being covered? You know, and there's a mother and
a father behind every one of these deaths that are dealing with that tragedy.
And so then I got drawn in a little bit.
And there was one dinner after we'd given our
first vaccination grant. I think it was 125
million. All these doctors came. And they're
they thought, "okay, this is a dinner where I'm
supposed to just say thank you, thank you. And
you know try not to use the wrong fork or something."
So they're there, and you know it's a nice
dinner. But after about 15 minutes I say to them,
"yeah. Well, it's okay. You've thanked me enough.
But what would you do if you had more money?" And
they're all kind of like, "well, does he really mean that? Is he serious?"
I said "yeah, what if you had, you know, ten
times as much money. What would you do?" And then
the guy who's worked his whole life on Hepatitis
B speaks up and the guy who's working on AIDS
speaks up, and the guy who's working on Immucocal speaks up.
And so it started opening the door to saying, you
know, it's sort of a 'bad news' story in that
governments are not giving the money, they're
treating human life as being worth a few hundred
dollars in the world at large. And that's, you
know, in almost a factor of a thousand difference
between how it's treated in the rich world versus in the rest of the world.
MOYERS: Oscar Wilde once said, "it's the mark of
a truly educated man," and I'm sure he would
today say woman, "it's the mark of a truly
educated man to be deeply moved by statistics."
What is that capacity that enables someone to
transform a fact or figure on a page to a human being a long way off?
GATES: I think there is a general difficulty of
looking at a number and having it have the same
impact as meeting a person. I mean if we said
right now, there's somebody in the next room
who's dying, let's all go save their life. You
know, everybody would just get up immediately and go get involved in that.
When my daughter whose 7 saw this video, you
know, showing the kid who's got difficulty
walking because of polio, her reaction was: "Who
is that? Where are they? Let's go help them.
Let's go meet that kid. What if he gets polio in his other leg?"
You know, so she's immediately drawn into that human on the screen.
It's a lot easier to connect to the story of the
one person or the five people. It now, you know,
because I'm mathematically literate, you know I
know that when there's 3 million kids every year
dying of things that are completely preventable
with the technology we have today. You know I can
try and magnify how I feel about that one
situation by a factor of 3 million. It's tough.
But at least you know it's super important.
MOYERS: What does it say to you that half of all
15 year olds in South Africa and Zimbabwe could
lose their lives to AIDS? What does it say to you
that 11 million children, roughly, die every year from preventable diseases?
What does it say to you that of the 4 million
babies who die within their first month, 98
percent are from poor countries? What do those
statistics tell you about the world?
GATES: It really is a failure of capitalism. You
know capitalism is this wonderful thing that
motivates people, it causes wonderful inventions
to be done. But in this area of diseases of the
world at large, it's really let us down.
MOYERS: But markets are supposed to deliver goods and services to people.
GATES: And when people have money it does. You
know when our foundation is not involved in the
diseases of the rich world. Not, you know, those
are very important, but the market is working
there. Between the basic research that the
government funds, through NIH. The bio-tech
companies. The pharmaceutical companies. You know
incredible things will happen with cancer and
heart disease over these next 20 or 30 years.
Because that's a case where capitalism is at work.
MOYERS: There's a profit in it. There's a profit in it.
GATES: Right. Here what we have is, with the
plural disease, not only don't the people with
money have the disease, but they don't see the
people who have the disease. If we took the world
and we just re-assorted each neighborhood to be
randomly mixed up, then this whole thing could get solve.
Because you'd look out your window and you'd say,
you know there's mother over there whose child is
dying. You know let's go help that person. This
problem, the lack of visibility, it's partly you
don't read about it, you don't see it. It's the
silence that's allowing this to happen.
MOYERS: Was there an "Aha!" moment? Was there a
moment of eureka when you realized what you're
just saying and said, "this is where we're gonna put our billions"?
GATES: I know when I saw that article on the
World Development Report, I said, this can't be
true, but if it is true, this deserves to be the
priority of our giving. And so I took the article
and Melinda read it. I gave it to my dad and
said, you know can you have the people you're
working with, tell me is this some aberration
here? Or if this is true, give me more things to read.
It was a shock, but then, you know it was an
answer to say that governments weren't doing it.
And so maybe we could help step in. And maybe not
just our resources, but maybe we could galvanize
some interest and attention and IQ to go and look
at these problems and think you know if I have
the technology that can you know stop mosquitoes
from carrying these diseases. Or allow vaccines
to be delivered without a refrigerator, you know
I have saved millions of lives by coming up with those ideas.
MOYERS: I talked on Saturday to one of the
leading public health officials in the world. One
of the pioneers in this field. And he said you
once asked him for a list of books. And he
provided you with a list of books. And the next
time he had seen you just a few months later,
you'd read 17 of them. I mean do you ever read
anything for fun? Do you ever read your e-mails?
GATES: There was about six months where I was
carrying around about 10 issues of The Morbidity
& Mortality Weekly Report. And people would see
that on my desk at work and what the heck? You're
reading The Morbidity & Mortality Weekly Report.
You know I'd say to them, yes, use this one from
the 1980s when AIDS came out. This is a real collector's item here.
Actually it's taken a lot of different books to
get you know the different perspectives and try
and understand what could be done.
MOYERS: It's one thing to read a book, it's one
thing to read the statistic, one thing to read a
graph, it's another thing to read a human being's
face. Did you go into the field?
GATES: Yes. And it's awkward. I'm not you know
particularly good at this. Maybe I'll never be
good at it. But to walk around to each patient
and ask you know what is your problem? And be
respectful of, you know, their desire for privacy.
But I think it is very important. If people got
out like that you know these problems would get addressed.
MOYERS: There was a trip you took to Soweto in
South Africa that was decisive in your thinking. Tell me about that.
GATES: Well we took a computer and we took it to
this community center in Soweto. And generally
there wasn't power in that community center. But
they'd rigged up this thing where the-- the cord
went 200 yards to this place where there was a
generator. You know powered by diesel. So this
computer got turned on. And when the press was
there it was all working just fine.
And it-- it-- it was ludicrous, you know. It was
clear to me that the priority issues for the
people who lived there in that particular
community were more related to health than they
were to having that computer. And so there's
certainly a role for getting computers out there.
But when you look at the, say, the 2 billion of
the 6 billion the planet who are living on the
least income. You know they deserve a chance. And
that chance can only be given by improving the health conditions.
GATES: the thing that's so stark is that you're
in Johannesburg which is sort of a first world
location. And you're talking with banks about
their software and you know it's, if you like,
it's not that much different than being in the United States.
And then you drive about 5 miles and you're in
one of the most poor areas you've ever been in.
You know those houses that are built out of the
corrugated iron which you know and the heat is just unbearable.
It's very jarring to go from this experience in
the city and to this other experience and have
them be so close together. You think well how
come it's so different in such a small distance?
MOYERS: What is your answer to how it is that the
resources of the world are so misallocated?
GATES: It's a mistake.
MOYERS: But somebody has to make a mistake. Who makes it?
GATES: I think we make it every day by thinking
that national borders are you know allow huge
inequities to exist across those borders.
And I do think this next century, hopefully, will
be about a more global view. Where you don't just
think, yes my country is doing well. But you
think about the world at large. There is one
excuse that people have for not paying attention
to this. It's not a valid excuse but.
And that is that things have been improving
despite the research money not being in place
applied the right way. Infant mortality or life
expectancy, even in the countries in the worst
situation, infant mortality is lower today than
it was in the best country 120 years ago.
Now there are things that come along like the
AIDS epidemic that send it in the other
direction. And we shouldn't be willing to wait
you know and have it take 50 or 100 years for
these medicines, the new vaccines, that kind of treatment, to be wide-spread.
MOYERS: Have you made any progress on safe birth
reproductive family planning issues?
GATES: Yes. There's a measurable impact when you
can go in and educate families, but primarily
women, about their different choices.
There's real impact that you can have in this
area. Anything to do with reproductive health.
Whether it's maternal mortality, infant
mortality, there's new ideas. There's more people getting involved.
MOYERS: One of my colleagues accompanied your
father and Jimmy Carter when they went to Africa
not long ago. The footage was striking. There was
your father and Jimmy Carter, the former
President of the United States sitting on the
doorstep talking about condoms as if you were
talking about computers. Are you comfortable
dealing that openly with people's habits? People's behavior?
GATES: Well, it's interesting. The AIDS is a
disease that is hard to talk about.
MOYERS: That visit that my dad did, the Health
Minister had never been in that neighborhood. And
so they invited him to come. And people didn't
think he would. But he actually did come and then
got involved and said, okay, we're gonna do free
condom distribution to this neighborhood because
of the impact that that can have.
MOYERS: Someone told me, actually a couple of
weeks ago that, we'd actually be better off if
you'd spend more money on distributing condoms
than on this research on AIDS at the moment. That
it's the immediate need that people have to you
know about their behavior that is the biggest
problem the world faces with AIDS. What do you think about that?
GATES: The ideal thing would be to have a 100
percent effective AIDS vaccine. And to have broad
usage of that vaccine. That would literally break
the epidemic. Because that it's not known how
long that'll take, and the best case is probably
in a 10 to 15 year timeframe, we also have to put
huge energy into treatment of the people who have it today.
We've got to put a lot of money into changing
behavior. Which we've funded a number of things
in that. And there's even an intermediate
intervention that we think is very important, which is a microbicide.
MOYERS: A what?
GATES: A macrobicide.
MOYERS: What is that?
GATES: Okay that's a gel that a woman could use
to block sexual transmission without the male
even knowing that it's being used, ideally.
MOYERS: That requires a great discipline of
passion and the question that arises you know how
to motivate your Microsoft employees. You know
how to affect their behavior by the rewards that
you hold out. How does the world affect the
behavior of people at a sexual level?
GATES: It's a bit
that's a very tough problem.
It's particularly tough if political leaders
aren't willing to speak out. You know there's
been really just a few countries where the
politicians said, this is so important for the
welfare of our citizens. And even though it
involves you know drug use, and sex workers. They
were gonna get up and say that it was a crisis
for the country. That happened in Thailand.
MOYERS: Right.
GATES: That's the only country that really caught
the potential epidemic at the early stage. It
happened in Uganda but it happened after the
disease had already progressed to about a 20 percent prevalence.
It's not happening to the degree it should in
other countries. And anyone who thinks it's
confined to Africa is gonna get quite a wake-up
call that already in India there's been five and
10 million people who have AIDS. And it's only a
question of how many tens of millions or you know
perhaps more than 100 million people in India who will get this disease.
And yet, intervening early, is when you can the biggest effect.
MOYERS: I interviewed Dr. David Ho a couple of
weeks ago. He's made the great research
breakthrough TIME's Man of the Year for it.
He's now worried about China, where his forbearers came from.
GATES: I was in China just two weeks ago talking
to the Health Minister and talking to Jiang Zemin
about raising the profile there.
And they have for their level of income quite
a strong health system. And quite, you know, a
willingness to say, okay, if this is about sex
workers we'll go in and we'll register the sex
workers. And we're gonna make sure that certain
behavioral changes are taking place, like Thailand did.
And so I think the right thing will happen there.
They will need international support. They'll
need more encouragement to make sure it gets done.
MOYERS: What do you think about the Bush's
administration retreat from women's health
issues, reproductive rights around the world. Not
only their retreat from it, but their outright
opposition and their effort to impede it?
GATES: We've got to make sure that that money
really gets allocated. And we've got to make sure it gets used effectively.
MOYERS: But they're not supporting contraception.
They're not supporting condom distribution. They're not supporting safe sex.
GATES: Part of the problem is that the citizenry
doesn't speak up enough and make it a big issue.
MOYERS: You know mean make global health a grassroots issue?
GATES: That's right. And yet if you grab somebody
and say, do you care about this thing
MOYERS: Yeah.
GATES: You can engage them very quickly. But it's not on the agenda.
MOYERS: How do we do that?
GATES: And so well, I'm thinking a lot about
that. I'm interested in any ideas. Because this
is about human welfare. You know, how we deal
with the AIDS epidemic should be one of the
greatest ways that the world gets measured. The
report card for this era these next few decades.
A big part of that grade should be, did we apply
all of the world's resources and activities and
visibility against the AIDS crisis. And yet, to
the average voter, you know, it's not on the
radar screen. There's only about $6 a year given
to world health issues by the U.S. and we're quite a legged in our giving.
We have to go out and regalvanize people that the
role of the United States is not just what we do
in the area of security, it's also sharing our
advances and our resources. And if somebody wants
to think about the chance of terrorism in the
decades ahead, I think this issue of how young
people outside the U.S. think of our country;
what is the role of the U.S. in terms of creating opportunity for them?
And if we don't step up to these health issues,
you know we're really not answering that critical issue.
MOYERS: What would you like the average American to know about global health?
GATES: I think understanding the basic facts
about the AIDS epidemic is important. I think
knowing how little resources are going into these
things. Knowing that this is not a case of
government waste. I mean there's this notion of
government spending in general and foreign aid
that often ends up in some dictators bank account.
In the area of world health, we're actually
coming into the country with vaccines. And you're
working at the village level to measure coverage
there. There we can be very effective. This is
not money that 20 years from now we're gonna wake
up and say, how was that money spent? We'll know
how it was spent because we look at the stopping the disease progression.
And so it is a special thing that the cynicism
about government spending should be suspended
here because it can be handled in the right way.
MOYERS: In this country we have eliminated
diphtheria and whooping cough. All of those
childhood diseases that were still prevalent when
I was a kid years ago. The vaccines exist but we
do not get them to the people whose lives
the
children whose lives would be saved right now if
they had it. Why don't they get to the people, the kids who need them?
GATES: Well the biggest single initiative we've
done is the vaccine fund. And that was 750
million to galvanize the world to say, okay let's
enter a new phase where we raise vaccination
coverage from the little bit less than 70 percent
it is today. And we get the new vaccines in there.
You know the Hepatitis B, the pneumococcal,
there's about four that we have here in the U.S.,
that are not being given worldwide.
The total cost of getting vaccines, a package to
a child, is about $30. And even if we add in the
new vaccines, we'd still be at less than $50 of
cost for this delivery. And so that money which
was supplemented to some degree by governments
and others but not as much as we had hoped is
very directly related to this vaccination coverage.
MOYERS: What do you think are the major diseases
that we're gonna have to deal with in the next 25 years?
GATES: Well top of the list is certainly AIDS.
It's very epidemic. And I don't think AIDS even
recognized how bad the epidemic could become.
If you were gonna design a bad disease you
probably couldn't do something worse than AIDS.
The latency, the fact that you're infected and
you don't actually see the health effects till
six to eight years later, that causes people not to understand what's going on.
You know take something like smoking: say that
instead of dying 30 years later of cancer, that
instead you smoked and you just dropped dead
right then. You know people would get the
connection. Oh. He smoked. He died. That's not good. Let's not smoke anymore.
Well AIDS is like that, where you just don't see
the impact on a society. You know if people,
someone visiting a sex worker walked out and they
just fell on the street, you know there would be
a pile of bodies there and you'd say, okay something's going on here.
The fact that there's these little epidemics of
hemorrhagic fevers, they get incredible
publicity. Ebola, Marburg, Lassa. You know and
it's literally in the hundreds of people. But
because it's all of a sudden that they die, that
gets more visibility almost than AIDS gets.
GATES: You know plane crashes in India and the
same day the plane crashed 8,000 kids died of
things that could have been prevented. Which gets
the coverage? Well, you don't expect coverage
every day, but maybe at least once a month they
ought to just say, by the way, every day this
month, we don't want you to forget, just two
paragraphs you know. 8,000 people are dying every
day. And we'll let you know when it changes, but
so far it's been that case for a long, long time.
MOYERS: Isn't it true that in Africa more
children die of respiratory illness than people die of AIDS?
GATES: Because of this latency, 5 million people
were infected this year. And so AIDS will be #1
in terms of the cause of death. Infant mortality
is still higher, and the biggest piece of infant
mortality is acute respiratory infection.
MOYERS: Yeah.
GATES: Generally pneumonia-related diseases. And
so they both should be dealt with. In fact there
are vaccines although they're still very
expensive, that can deal with the respiratory problems of infants.
MOYERS: Are you looking for a vaccine for
malaria? Because malaria kills a lot of people.
GATES: Yeah. In terms of what's #2, you'd
probably put malaria. Malaria not only kills a
million people a year, but at any time there's
300 million people who are being debilitated by the disease.
And if you took the top 10 diseases that are
really troublesome in Africa, a lot of them you
wouldn't know the names of. I mean you know Lice
Maniasis, Sisto-Somaisis. Even something like
trachoma that wouldn't make the top 20.
MOYERS: Trachoma is?
GATES: It's
you get an infection in your eye and
you start itching and it's the leading cause of
preventable blindness. Because eventually you
itch and your eye turns in and you lose your
sight. And yet you know Zithromax is this
anti-biotic that if you give it-- actually can
prevent the disease. And if you get enough people
taking it then you stop the spread of that
disease. And yet it doesn't
it wouldn't make the top 20
MOYERS: Can you think we will find a vaccine for
malaria? Some people say it's impossible. It's such a complex disease.
GATES: No doubt. First of all, I'm an optimist,
so
I should explain that. But there is
with
malaria, there is innate immunity. That is if you
get the disease, you are
it's very
except for
different strains, you don't get it again. And so
the immune system clearly does recognize
something in the course of that disease.
And so all we have to do is take the sequencing
information and try and find out what that is.
You know I'd say quite certainly within the next
20 years and ideally in the next 10 we'll have a good vaccine for malaria.
MOYERS: In business, the market kicks you in the
pants if you make a mistake. In philanthropy,
some of your mistakes are celebrated because you
gave the money and nobody ever came back to ask what happened?
GATES: We have to be really brutal with ourselves
on this. We will make mistakes.
But then again, you've got to take risks. I mean
that's one of the things a philanthropist can do
that governments aren't as well suited to do. A
politician doesn't want to allocated money if
it's a one out of three chance of doing something
really good, because, you know, then two out of
three they'll have to stand up and say it was a waste.
Whereas a philanthropist can say, "Okay. But we
will take that risk." Because the payoff would be
there. And, you know, we're
I'm not gonna get
voted out of office if in fact it's a dead end.
So we should be doing the things that the normal
approaches can't do, whether it's approaches to
the AIDS vaccine or malaria or delivery systems.
We've got to be out there and accept some kind of failure rate.
MOYERS: Is the basic problem that we don't have
enough knowledge to solve global health issues?
Or is it poverty? I mean if I'm forced to live on
$1 a year, I'm not gonna be able to afford any
medical care
I mean $1 a day. I'm not gonna be
able to afford an aspirin. I'm not gonna be able
to afford to make that trip to that clinic.
Your children, my children, my grandchildren. We
can afford, they can afford decent medical care.
Isn't poverty the real issue here?
GATES: It shouldn't be. The benefit to the world,
both on a humanitarian basis but even on a pure
economic basis of dealing with these diseases is
it's quite clear and quite positive. I actually
get angry when people try and justify these
health things in economic terms. You know like
you'll read a paper that says, you know, "If
malaria was cured, the GNP of this country would be 30 percent higher."
That gets it so backwards. I mean it's true.
Statistically it's true and I suppose there're
some audiences that you've got to use that
argument. But the whole wealth is a tool to
measure human welfare. It's just a tool that we
created to help us sort of incentivize people and help get things done.
If death doesn't get reflected in GNP, then that
doesn't mean it's unimportant. If the suffering
in malaria doesn't get reflected in those
numbers, it's still very important. So we
shouldn't have to resort to these economic arguments.
Some people resort to security arguments. They
say, "If we don't cure these diseases, the
instability in these countries will be bad. And,
you know, that could be scary." Or they resort to
the, you know, "It's coming to your neighborhood
argument." That, you know, somebody could get on
a plane from one of these places and, you know,
you might get sick. I mean don't worry about
these people, but you might get sick.
And those, you know, those arguments, if they get
more money for world health, then fine. I won't
object. But they're wrong. The right argument is,
you know, this mother's child is sick. And that
child's life is no less valuable than the life of
anyone else. And the world has plenty of resources to go solve these problems.
MOYERS: Let's say that everybody agreed with you.
That they wanted to do the moral thing. What
practically could we do? You've already admitted
the market doesn't get there. It doesn't get to
Uganda. It doesn't get to Nepal. It doesn't get
to Mozambique. It doesn't get to places where
people as you and I talk are dying from malaria,
tuberculosis, AIDS, all kinds of disease.
The market doesn't do it. How do we do it? Every,
you know, $27 billion is a lot of money, I think.
But it's a drop in the bucket compared to what
you've been describing. So what do we do practically?
GATES: For the U.S. to do its fair share, we'd
have to take the $6 per citizen that is spent on
foreign health issues and we'd have to raise that to $30 to $40.
And if other rich countries did their part, then
there would be the money to give the vaccines, to
create the new vaccines. To give oral rehydration
therapy. To have the education in the villages.
You know then the whole picture of health would change quite dramatically.
You know public health doctors I know talk about
the positive feedback loop in poor countries. If
parents believe their children will get better,
they save more and they reproduce less, therefore
there's less money
there's more money for other
things. Do you accept that as a workable theory?
GATES: Absolutely. And that is the most amazing
fact that should be widely known. You know
essentially Malthus was wrong. If you raised
wealth and you improve health, particularly if
you educate women, then this virtuous cycle kicks
in and a society not only becomes
self-sustaining, but it can move up to a fully developed status.
The Club of Rome was writing about how we were
basically headed towards a disaster. That the
amount of food that the world would produce would
be inadequate and you know that things would just
get worse and worse and worse.
Well, now at least in the countries where health
has taken hold, we're seeing literacy rates
improve. We're seeing, you know, everything about
life improve. Once you get this one thing right.
And that was something that was quite a
revelation to me. I, you know, I frankly thought
that the Malthusian principles applied at least in the developing countries.
But because of computer technology now in
medicine, advances will move at a incredible
pace. The next 20 or 30 years will be the time to
be in medicine. Many of the top problems, I'd say
most of the top problems, we'll make huge advances against.
Just think about a kid who's curious, say, about
malaria. They can go onto the Internet today and,
you know, see what's going on. Try, you know,
they can even see the genome if they want. They
can see the papers that have been published by different labs.
So I get very excited about how the generation
that's coming into health right now, the
visibility, particularly of these poor world
diseases, you know the information now is in
their hands. And they ought to be able to do quite a bit with it.
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((Udhay Shankar N)) ((udhay @ pobox.com)) ((www.digeratus.com))
