Bill Gates thought that coming up with vaccines would be the hard part and that delivering vaccines would be the easy part.
It turns out they are both hard.
That's one of the lessons that Gates tells CNET he has learned in his new role as full-time philanthropist. In travels to Africa, he saw firsthand the challenges of delivering vaccines, many of which have to be kept cold to be effective and are needed in places with no refrigeration.
"We were a bit naive about that, particularly getting new vaccines adopted by countries," Gates said in an interview last week. "It had been so long since they had done it, I just assumed they would look at the numbers, it would be a very straightforward process. Well, the process doesn't even exist."
Plus, he said, "The cold chain is more messed up than I expected."
In the interview, which was done in conjunction with the release of the annual letter (PDF) from the Bill and Melinda Gates Foundation, Gates talked about other surprises he encountered in his travels, including the fact that one of the ways to reduce the spread of AIDS in Africa is to promote adult circumcision--something that he wasn't sure would be feasible.
"Male circumcision--which I thought wouldn't be a big effect because I didn't think adults would be that interested in it--it looks like that's really going to help slow the disease," Gates said.
Gates also talked about his recent
"The Internet is tailor-made for the kind of activities I'm involved in," Gates said. "When I take a trip, we have all these photos. And there were things that were fun and exciting, and people want to see that. It's very easy to put it up there...I think it's going to be a lot of fun to be sharing on an ongoing basis, and people who are interested in a particular topic can just find that piece and go after that."
Gates also discussed the classes he is taking online, the response to the earthquake in Haiti, and the need for breakthroughs in clean energy.
Here is an edited transcript of the conversation:
Q: In one recent interview I heard that Melinda said [of you] that, "Bill's on fire." What are some of the things that have really ignited your passion further in this past year?
Gates: Well, the opportunity to go into the field and see both the need and the progress makes this a really fun job. I was in Kenya and South Africa in December and saw the AIDS epidemic, which is still really awful in both of those countries, but I saw a lot of hope. Male circumcision--which I thought wouldn't be a big effect because I didn't think adults would be that interested in it--it looks like that's really going to help slow the disease. So I'm excited that I get to take my belief in science, backing scientists doing great work, and the practical notions of how things get organized, how they get done, and do my best to apply them to the needs of the poorest.
I hear that one way that you approached this year's [foundation] letter was to look at what it might be like to write that letter in 10 years if there weren't any innovation. What were some of the things that went through your mind as you started thinking about it that way?
Gates: Well, innovation is often this hidden thing, because we can't put numbers to it. And yet it's the thing that defines the way we live, the things we'd like to have for everyone whether it's health or education. Where does the marketplace fall short and therefore a foundation can have a catalytic effect?
What types of things is innovation critical to solving?
Gates: Well there are great examples from both the United States and from Africa. If we don't innovate in education, the budget cuts and increasing expense of a really great university education, it's literally going to mean less people get to go have that education at a time when more people are going to want it, and the country needs more people to get those educations. I call it the $200,000 education, because if you pay the full amount to a private university, that's what it costs.
So how could you get that to be available to lots more people? How could you avoid that kind of bleak, "years ago things were better"-type outcome? Well the answer is that we've got to innovate. We've got to put courses out on the Web, we've got to put interactive learning out on the Web.
Likewise, for some of these health problems. If we don't solve them, then the population growth that comes with bad health, we will overwhelm what Africa will be able to do in terms of jobs and education and just feeding people. And so we've got to make progress now in order to not just straight-line that population growth which would make Africa far worse than it has been.
The letter talks about some of the incredible traveling you did. One of those trips earlier in the year was to India, I think it was your 12th trip, if I'm not mistaken. One of the projects that you saw was something called "scuba rice," an effort to make rice that is more flood resistant. How important is it to create more weather-resistant crops?
Gates: Even today people starve or live very poor livelihoods with not enough calories or not enough crops to sell some to get money for school fees because of weather. Weather is a super tough problem, and weather is going to get worse. That is, climate change means that there will be more rain when you don't want it, coming all at once. There will be periods with no rain, drought. And so taking these crops, about 10 crops that are used to feed most people, and improving the common varieties--and there are a lot of varieties for some of these seeds so they can deal with the drought or flooding--is critical.
And rice, there was this amazing breakthrough where just by putting one gene in you can take it so when the rice gets flooded it will just wait until the flood goes away and then resume growth. So if you put two fields next to each other, the current rice variety and the one with this new gene, then after the flood comes, you'll see complete die off without the gene, and great rice that's literally unaffected where you've got this new gene. And we've been able to transfer that gene into many rice varieties. And so it'll improve the lives of hundreds of thousands of people. Now the other traits like drought resistance may not be as easy, but they're equally important and that's why we need to invest in that science.
Also you met with some of the political leaders in India. What are some of the issues going on in India that you are most passionate about?
Gates: Well, India is quite a mix in terms of the quality of health care. In the south, a state like Kerala, the health is not much worse than a middle-income country. Whereas up in the north, Uttar Pradesh, Bihar, you have some of the worst health conditions anywhere on the planet. You have less kids being vaccinated, more kids dying of measles up there than anywhere else. And so the need to step back, build a better system, make sure that the government money gets to the people who deserve it. Vaccination is one of the easier things. It's much easier than roads and a great education system. It's very basic. It's one of the first things you want to get right.
And what I'm seeing is that there's a set of leaders who are very interested in this and have some new tactics. They're realistic about how hard it is. I mentioned Rahul Gandhi, whose mother is head of the Congress Party and is very involved in building up a new generation of politicians that are going to be more interested in these development issues, and the actual delivery that is what makes the difference. So I was very optimistic after several of those meetings.
In December you traveled to Africa. One of the things you saw firsthand was in Kenya, where they're using cell phones to do money transfer and you saw some of the micro businesses that sort of technology enables. How far has that gotten and what are some of the challenges still there?
Gates: Well, the pervasiveness of the cell phone is very strong even in quite poor countries. And so we can often think for health or savings, how can you take advantage of that? It's not going to be easy, because you've got to have a simple user interface, and you've got to have very cheap transaction fees. And yet we've seen now in Kenya, that with the transfer, money transfer system they call M-Pesa, it's really started. And so the idea that with very low fees you could track your savings and [could] loan money to other people. That really would be a breakthrough. Right now the actual fees involved in financial services are the worst for the poorest, because as a percentage they're just too high. So we need a breakthrough. It's one of those catalytic elements like food or health that would make a huge difference. And in this case, a lot of it's sort of a pure software thing that is more like my traditional Microsoft work.
When people think of the foundation's work, they tend to think of the developing health work overseas, but another big focus as you mentioned is education here in the U.S. We've talked in the past about some of the possibilities that are out there in terms of recording some of the great lectures that are taking place and making them available online to students everywhere. I understand you have been doing a lot of beta testing of some of these online classes, taking classes from MIT and elsewhere. What are some of the things that you've seen as you've taken some of these classes?
Gates: Well, a great lecture is a phenomenal thing and no university has all the great lecturers. Once you identify who is good, then you can help them record it in a high-quality way. You can give them resources to do the experiments and demonstrations even better and get something that's quite phenomenal. Online for mathematics or physics, there should be just phenomenal lectures. And that really is happening. I mentioned Academicearth.org in the letter as a place where they're collecting and letting you connect out to a lot of different courses. And the site gets broader as it reaches down into high school, across a broad range of subjects--and also includes interactive testing, to see if your knowledge is right.
I think it can be a great tool. I love the Walter Lewin physics courses, I love the Don Sadoway materials science course. I need to learn a lot about these sciences [for] the health and agriculture work of the foundation, so I'm smart about those things. And I love watching them. It's kind of there as a complement to the for-profit stuff, which are organizations like Teach 12.
Beyond letting you make up some of the college work that you might have missed, you talk about this as a foundation for improving the higher-education system. I think there's some research from Carnegie Mellon that actually shows that by mixing live discussion with online lectures students actually retain more than if they were sitting in the actual lecture all the time. Is that some of what you guys have seen?
Gates: Yeah, well online is pretty special for two reasons. One is that you can get the very best lecture in the world and wherever you are, whenever you want, you can connect to that lecture. That's video on the Web, and it wasn't possible even five years ago. The other is this interactivity, where if you know a topic, you can kind of skip over it. Or if you're confused about it, [the area] where you're confused can be analyzed by software.
That kind of personalized learn-at-your-own-pace type approach is pretty phenomenal. The example of a kid whose math score is not good enough and he's stuck in remedial math, it's kind of awful because he's not sure what he got right and what he got wrong and he's been given this negative feeling of, "OK, you're not good at this." But as he's sitting through lectures, a lot of it's stuff that he already gets and some of it needs more depth, which is maybe fractions or scientific notation. They just weren't explained well, they weren't the right examples. And this mix of showing you visually, showing you in different ways, can help you learn something. For me, certain complex concepts, I actually watched multiple of the physics courses just so I say, do I understand this, say, cardinal limit. If I see it from multiple [teachers], it strengthens my understanding.
Beyond the vaccine research and expanding antiviral treatments, one of the things you talked about is the role that circumcision can play?
Gates: Certainly, being on the ground is crucial. It remotivates you, and you get to see what's working better or not working as well. Circumcision is definitely one that, although we put money behind it, I just didn't think the demand from adult males would be very high. That's a fairly personal thing. You'd at least think that it might be a painful operation. There are cultural beliefs that whatever you've decided to do you're probably comfortable with. So it's quite surprising to me that in multiple centers, including this [inaudible] one in South Africa, the demand has been very high.
In fact in this one area, township, they'll get somewhere between 70 and 90 percent of the males to have this procedure. And that will dramatically reduce the spread of AIDS. It won't stop it, it doesn't make you invulnerable. But it's a big enough effect that this is a great intervention and to really believe it I had to sit and talk with the kids who were just coming out of the operating room or coming back for their 30-day check-up and say, "Why is the word of mouth on this so good? What got you to come here and what were the negatives?" And clearly those results are the real thing.
For a long time I know you've sent e-mails to some of the people you're closest with. Now you're starting to broadcast that a little more broadly. You just joined Twitter obviously, and you're launching a new site, Gates Notes, where you share some of these things. What are some of your goals with these new methods of communication?
Gates: Well, the Internet is tailor-made for the kind of activities I'm involved in. When I take a trip, we have all these photos. And there were things that were fun and exciting, and people want to see that. It's very easy to put it up there. It's almost no additional work at all. If I read a book, some people are considering whether to read that book or just want a short understanding of what that's like.
So I think it's going to be a lot of fun to be sharing on an ongoing basis and people who are interested in a particular topic can just find that piece and go after that, because the variety is such...nobody is going to be interested in all of it. And it will help guide me, the interest in some of the energy things I have been doing is very high and so I'll elaborate more on that.
It's great to be part of a virtual community, and I have sort of been out of it. Because after I left Microsoft, I didn't create my own Web presence. And so for the last two months I've been thinking about it, decided to go ahead, and these last few days I'd sent out quite a few tweets. And I'll learn about this and it'll keep me up to date.
It seems like these social media are actually changing a lot of the work that your foundation and other global philanthropy do in terms of getting communication in a different way. One of the places we've seen this is the response to the earthquake in Haiti. We've seen text-based donations coming in. A lot of peer pressure of friends saying, "Have you donated?" Is it making the work that the foundation does easier or is it just a different means of communication and you have the same level of interest that has always been there?
Gates: I think it's more of an opportunity than an established thing. The overall generosity of America to the developing world causes is higher than most countries, but still quite modest. And you often, you'll see a peak in a disaster, but the real needs are the ongoing needs, so then you'll see the drop-off. The opportunity to have ongoing awareness where somebody can pick a particular country, a particular disease, the needs in farming. Whatever they're interested in and feel involved that they understand where they could travel, where they could give their time, where they could give money. What the policy issues are to be as a voter, having an impact. I think the opportunity is quite dramatic. And yet, so far the gross numbers in terms of generosity are not substantially changed from the past. So it's still in front of us to have that benefit.
Energy is a topic you mentioned a couple of times. It's something I know you're really passionate about. It's not something we've heard as much from you about, but you reference it at the end of your letter. What are some of the energy issues that you've been spending your time thinking about and what are some of the things that you're encouraging others to do?
Gates: Well, there's one breakthrough that is called for, and that's the ability to generate electricity with lower cost than we get it today, but no CO2 emission. And there are many paths to get there, and none of them are easy paths. We need to back a lot of them. And so I spent time with a lot of scientists, talking about these things. In fact, Nathan Myhrvold's got a group together that has done some very interesting invention around these topics. We've actually spun out a new company. A nuclear-energy company, which sounds a bit unusual, but it's got a breakthrough approach that avoids some of the top problems. And we need a lot of companies like that. I invested in
For rich people, yes, we can use less energy, we can afford a higher price. For the poor, a higher price of energy would mean that their life would be much worse. They couldn't afford as much fertilizer, they couldn't get to their job, they can't get clean water. So the progress of civilization has depended on and will depend on energy being cheaper. But now we have this constraint of not just less CO2, but no CO2. Conservation can give you reductions, but the number we have to have is zero. And so what you have to invent is not just efficiency, it's a whole new way of creating electricity that can meet the overall demand. So a fascinating topic. [It] fits that innovation framework and yet there's a private market, so the companies doing this work are private companies where the employees get some of that upside and many of them will fail, in fact the vast majority. But all we need is a few to succeed to take on both helping the poor and getting the climate change problem under control.
I know you're a huge optimist. At the same time I know you're also pretty self-critical. When you look back at the past year, are there things that you would give yourself lower marks for, or that you would say this turned out to be more difficult than you thought? ?
Gates: Well, vaccine delivery is one where I thought we actually understood all of the complexities. And we were a bit naive about that, particularly getting new vaccines adopted by countries. It had been so long since they had done it, I just assumed they would look at the numbers, it would be a very straightforward process. Well, the process doesn't even exist. The cold chain is more messed up than I expected.
The process you need to keep things refrigerated?
Gates: Exactly, to keep them fresh so they work when you finally get out to that child who needs it. And so vaccine delivery sort of moved on beyond, and now I realize both the foundation and I need to spend a lot more time on that because we have ambitious goals there. It's going to hold us back. So that was a bit of a mistake. And the agricultural front, the resistance to these transgenic approaches. I thought that would have died down some as the huge benefits to the poor, particularly the poor dealing with climate change caused by the rich. I thought that would be less and not such a blocking thing, but it's still a huge issue. And some of the advances rely on those techniques, so it's important to fund the African governments so they can make their own decisions and try not to have this blocking that [as] is the current status and much worse than I had realized.
It seems like the hardest problems are--the science is hard, but people seem to figure out it's the politics that can be the least predictable?
Gates: Well, I think you get both. If we had an AIDS vaccine, I don't think the politics would stand in the way of that much, or a malaria vaccine, or a TB vaccine. As you get down to diseases that are a little bit less visible, that's when it gets more difficult. So for each problem you have to see what the mix is. One that I highlight is these deaths of children for their first 30 days. Where it's both a delivery problem of educating mothers, but it's also probably the case where we need some new pills, some new shots, and then the two are entangled. It's not [that] you have the science over here and the delivery and politics over there. It's all this one thing of getting in to the mother and talking to her. So we're putting a lot of energy into that type. Melinda's got a lot of trips particularly focused on that issue.
And you're going to be keeping us up to date on your Web site and then tweeting about them?
Gates: You bet. Maybe three times a week I'll have something, and maybe one of those will be a long thoughtful piece about a book or about a particular problem, and a couple will just be pointing to things where I think somebody is being really insightful, and maybe one a week will be more frivolous. I'm learning what people like and that's another fun thing for me this year. This is the year I return to the digital world.
By Ina Fried