Question. Why are you celebrating the Grand Challenges conference in Europe? Are you trying to raise the profile of your foundation?
Answer. We don’t have a general goal of raising the profile of the foundation. We do have a goal of getting more top scientists involved in global health research and highlighting the incredible innovations that are taking place and drawing more people in, so really articulating what the challenges are in global health. We’ve done grand challenges in lots of different places and I realize this is the first time we’re doing it in Europe. We do quite a lot of our science research here; the US is the place where we do the most, but if you take Europe as a whole it’s not quite as much as the US but almost.
Q. Does this link in with problems in Europe such as the migration crisis and the increased fear of terrorism?
A. The Foundation, since it got going in the year 2000, had global health as the top priority, and we picked global health because of the impact it can have on allowing people to learn better, to have enough nutrition. The very first thing to have a society be self-sufficient is to get health to a certain level. Then you also have to aim to get culture and education up to a certain level, so getting all these countries to be self-sufficient is the end goal here. Eradicating or bringing to very low levels all these infectious diseases is another one of these goals. We’ve gotten a lot bigger over the years, we were very lucky. In 2006 we got doubled by the gift of Warren Buffet, and we’ve had good investment returns. We’re about five times larger now than we were then. We started out giving $1 billion a year in the early years, and now we’re up to about $5 billion.
The refugee crisis just reminds us that when we have people in these tough places, it affects all of us. It’s terrible to see and it starts to create huge problems. Likewise, when we have infectious diseases in faraway places it doesn’t always stay there. Particularly, the climate is warming and, as people are traveling more and more, a disease like zika or even ebola puts the entire world at risk. So having the ability to use surveillance to catch these diseases early, to have tools to either prevent or cure the disease – that’s something that affects everyone.
It’s sad to say that the Syrian refugee crisis is making people more aware of the tough conditions in poor countries, or that zika and ebola, which are both bad things, are making people aware of these diseases, while malaria, HIV and tuberculosis are still out there. Thank goodness science is making amazing progress.
Q. You have an aim to eradicate poverty by 2030. How can this be achievable?
A. The poverty goal, which we’re absolutely part of, is one of the grand parts of the sustainable development goals, the UN goals. We’re involved in a lot of pieces of that because health, including nutrition, is super important. The agricultural work we do, which is about doubling the productivity of farmers in poor countries including all of Africa, that’s a very key thing. For an economy to lift itself up, there are a lot of pieces: you have to have reasonable governance, reasonable infrastructures, but I’d say health, agriculture and education are sort of the underlying things. The world has seen massive reductions in poverty and one of the millennium development goals was actually exceeded, cutting poverty in half. Countries like India, Brazil, and Mexico… These are now middle-income countries, and it’s a huge change. In 1960, there were no middle-income countries, and 15% of the world was in developed countries – basically Western Europe and the US, Japan was just starting. Eighty-five percent were poor countries. Now the majority of all people in the world live in middle-income countries.
They’ve set a very ambitious target, around this 3% level. It’s fair to say that there are the very toughest countries in the world, the Democratic Republic of Congo, the Central African Republic... The chance of having eliminated poverty in the very tough countries by 2030 isn’t very high, so the end of extreme poverty by 2030 is not really a pure numerical goal – it’s an aspiration. We’ll be able to get rid of a majority of the extreme poverty.
The underlying thing, which is super important, is that poverty levels, in terms of “I don’t get enough food, I don’t get enough nutrition, I don’t have opportunities for education”… These things are really coming down dramatically and the public in general isn’t aware of this good news because they see that Sudan looks really bad, and Sudan is bad, but the fact is that even Africa – which is by far the toughest area for all these things we’re talking about – has improved dramatically.
And then there are the acute problems: Sudan, Yemen, Somalia and Syria are acute problems not to be understated in any way.
Q. Do you have the fear that the rise of populism or nationalism in Western countries might be a threat to international development and aid, to this positive trend you’ve described?
A. Absolutely. That basic move of humanity working together to solve problems, it’s not an absolute given that voters would always choose to engage. And some of these misgivings we see are reflected in certain countries, including the United States.
We’ve changed in ways such as racial equality, gender equality. There’s a lot of social change, and there is some backlash in terms of that. There’s a certain level of immigration. People are seeing more of a mix of people, and then there are economic things where with globalization there are some workers who feel that things would be better if there was less free trade. We have a variety of things, all of which fit in the turning inward versus embracing the world. In each country, how much of the mix of those things, are there aspects, such as helping workers out more when they’re displaced, that we should tune? Hopefully, politicians are looking at this somewhat surprising sentiment. It’s still not a majority sentiment but [it is] a meaningfully awkward sentiment, about people turning inward, and really trying to analyze what those pieces are.
Democracy is supposed to be a self-adjusting system where we listen to these concerns and figure out what the legitimate parts of them are, educating people about the parts of this that really are good policies. The aid budgets: the UK increased its aid budget substantially and got up to 0.7%. That’s an incredible thing they should be proud of, and that’s been an aspiration for European governments – to get up to that high level. The case of the Netherlands is unusual because they were at 0.7% and now they’re not. But the consensus is that we want that solidarity, we want to help out, even in the face of the fact that people see that from time to time some of that money is not well spent. Those stories are easier to tell than the overall story of how many kids are getting these new vaccines. The reason why the child death [rate] has come down so much is that GAVI [Global Alliance for Vaccines] was created back in 2000. Two of the first things our Foundation did were being one of the founders of this vaccine line, GAVI, and it was one of the founders of the disease line, the global fund, which is the one dealing with HIV, TB and malaria. So making sure those organizations are working well and delivering on their goals is a huge thing. Those are two of the biggest guarantees of the foundation of these two organizations, and the European governments are huge donors to both of them.
Q. Which one of the US presidential candidates do you think better represents your goals in those matters?
A. Well, there is no doubt that [it would be the] candidates who are more embracing [of] the US playing a strong role in helping out other countries. That’s a strong battle my wife and I have. We don’t actually say specifically who we are going to vote for because we are so closely associated with the foundation – it’s our full-time work – and the Foundation is nonpartisan so it has been able to work super well with all the different administrations since we have been around. It was the Clinton administration at the very beginning, then the Bush administration that did amazing things, being so generous on AIDS and malaria, and now the Obama administration. And whoever comes we’ll do our best to work with them, but… Historically, both parties have been good on these issues and easy to work with and we hope we don’t have to find out that some party is less international going forward.
Q. You and your wife have been named as potential ticket candidates by Hillary Clinton’s campaign. Is that something you could consider?
A. Well, neither my wife nor I are going to become politicians. We love the work we do at the Foundation. We do work very closely with all sorts of governments, but we think our foundation work is where we can have the highest impact.
Q. You put an emphasis on empowering women and girls as a driver for progress. How would a female American president make a difference in that matter?
A. Well, it’s always nice to have people see that women can do every job and have a role model in that job. So it’s a milestone. It doesn’t solve the fact that if you are poor, women are the people who will suffer the most from that. A group we work with called One has the slogan “Poverty is sexist.” We have a long way to go to have women get equal treatment. Melinda is very engaged on these things. And as countries get better off, fortunately, there is a strong trend that those inequalities are reduced. As we do all our work, seeing if there needs to be a gender part of the strategy is important. You know, in agricultural work, there are different crops that the women tend to work on and so making sure that they are getting nutrition. Like with chickens. It’s this fantastic thing if you can teach women to take care of chickens. It not only gives them an economic value for the family, it has a pretty direct effect on the nutritional richness of what those kids get. That is, you don’t have to add more than, say, an egg a week to fix a lot of nutritional deficiencies that African kids suffer from. Well, if [Hillary Clinton] is elected, I’m going to go and talk to her about chickens.
Q. You have complained sometimes that you and other people don’t pay enough taxes, but many multinational corporations, including Apple, Google and Microsoft, use legal loopholes to reduce their taxes. Isn’t it counterproductive towards your fight against poverty?
A. Well, I have always said that taxation in the US, which is the only country where I really understand the taxes, could be more progressive. So it’s a good thing that there is still room without creating huge disincentives. You know, I pay a lot of taxes. I’ve paid more taxes than any US citizen. I’ve paid over $10 billion in taxes. The whole thing about corporate taxation… If countries have a goal of collecting certain taxes from those companies, they should look at their laws and look at how they are structured. There are, I think, G-20 discussions through World Bank and various things like that to look at corporate taxation. The current structures are delivering a current result. Now maybe some companies are really pushing loopholes and going too far. I’m not aware of that. But mostly, what has been talked about is that with the way the structure has been set up, those companies end up being taxed primarily in low-rate jurisdictions.
Q. What achievements are you most proud of?
A. Well, you know, I have my Microsoft work, my Foundation work, and my family. I’m proud about each of those. For the Foundation, we’ve had the most incredible success in vaccination. We are getting these vaccines that were being given in developed countries where the kids were in a very low risk of dying from diarrhea or pneumonia and getting those out to all the children of the world. So that’s been a huge achievement. And we did that by working with the manufacturers, getting there to be more competition, getting the price down, raising money through GAVI, then working through the countries to get better coverage of the kids. That saved over eight million lives, the vaccine work. And then I’d probably put the Global Fund work. And we have tons of things, like polio eradication, which is not done, but we hope we are not far away from our plan over time to even eradicate malaria.
Q. And what would you say is the greatest global health challenge that is yet to be met?
A. Well, in the case of HIV, we still don’t have a vaccine to stop people from getting infected. And because the number of young people in Africa is going up a lot, unless we get some better tools, the infection rate is going to go back up. So HIV is a huge challenge. And nutrition is an area where we have made some progress, but not nearly enough. And there is even some scientific work that we are funding about what is malnutrition. Often kids will get enough overall to eat, but there are elements missing, like vitamins or micro-nutrients. Understanding what is missing, so that kids develop both physically and mentally, the world has a lot of work to do on that. And it’s a very critical thing, because it’s great for kids to survive, but you want them to survive with all their potential intact. In Africa, in over 40% of the kids, their brains don’t fully develop because of disease and nutritional deficiencies.
Q. Mark Zuckerberg said that he was committing $3 billion to eradicate disease and poverty. Is that idealistic in some way?
A. Well, certainly all those absolutist goals, when you say, ‘There will be no more disease or poverty,’ that idealistic stuff, but he gave himself until the end of the century. So your articles, checking to see if he did it or not, you’ll be very old when you write that article. Hopefully, because he eliminated disease, he’ll be very healthy at the time – you can thank him at that point! What he did is fantastic, and actually, when they had that announcement, other than the scientists and people involved in what they call the Chan-Zuckerberg initiative for help, I was the only one who was there talking and saying how helpful I thought it would be. In a sense, they are broader than us, they do all disease, and in a sense they’re narrower than us, in that they just fund the research portion, whereas we spend even more money on the delivery portion than we do on the research portion. We’re big, so we spend a lot more on research than they’re currently committing, but their thing is a huge commitment, it’s fantastic. When I was Mark’s age I was not doing philanthropy at all; he has started at a young age and he picked a lot of great people to be involved in that initiative.
Q. How about cancer? I read that Microsoft said that it can solve the problem of cancer within 10 years. Is that possible?
A. Well cancer is not a focus disease for the Gates foundation. The Microsoft stuff has to do with a partnership they have where they store sequenced information and they analyze sequenced information. They’re not a cancer researcher, but it turns out that these digital tools that they have are very helpful to spot patterns and know how to treat people. There is a lot of promise to that…
Q. But can they beat it, eventually, or in the mid-term?
A. It’s another one of these absolutist things, and I think Eric Lander did a really good call recently in the protocol as a scientific researcher, saying that in 10 years probably not, but that over time probably so. In a lot of these scientific things, we tend to overestimate what we can do in the short term and we underestimate what we can do in the mid-term. The progress in cancer is amazing and the digital tools play a small but critical role in that, where we’re sequencing all of these cancers. Medical science is in a golden era, whether treating diseases that are not the foundation’s focus or the infectious diseases that are our big focus, the progress is really incredible.
Q. It is said that you’re known to like to lunch on cheeseburgers. Isn’t that a health threat?
A. Well, when I’m traveling, I end up eating wherever the local cheeseburger is. When I’m at home with the family, we may have burgers maybe 5% of the time or something, so it’s not an obsession, it’s just the quick way to get a bite when I’m traveling, and it turns out to be easy. I’m not some paragon of my actual diet. A lot of diet is just the total amount you eat, and how much you exercise. I get to play tennis and those things.