Ahead of the release of Bill and Melinda Gates Annual Letter on February 13, Bill Gates, co-chair of the Gates Foundation, briefed a group of journalists from different African countries on the highpoints of the Annual Letter and a number of issues around health and development. The letter centred on ‘The 10 Toughest Ques tions We (Foundation) Get’ over the years from non-profit partners, government leaders, supporters and critics. Bill sees a world that’s getting better, saying the number of children who die every year has been cut in half since 1990 while extreme poverty declined by nearly half. Chioma Obinna participated in the telephone conference. Where do you feel your greatest achievement is: Microsoft or philanthropy? I think a lot of people would point to the Foundation, because, along with our partners, by getting out new vaccines and working with primary health care systems, we have gone from having over ten million children die under the age of five back in the year 2000 to now where it’s under five million. So that’s been pretty amazing progress. Also, although polio is not done, if we’re successful in getting rid of the last cases this year, that is something the whole world would celebrate.
Excerpts: Bill Gate
I personally find it hard to compare because I think software and the Internet are doing great things, and certainly, in my 20s and 30s, that’s what I was good at doing. And learning how to work with scientists and building teams, the skill and money were absolutely necessary for me to have the opportunity to be doing the Gates Foundation work. So I’m very lucky that I’ve had these two careers that are both fun every day and have had a positive impact. It was 10 years ago that I left my full time work at Microsoft and went to the Foundation. So that has been full time work for 10 years. Of course the Foundation started in a big way in 2000. And we have grown quite a bit in the past 10 years. The resources in the Foundation come from two sources: The success I had at Microsoft and the success Warren Buffett had at Berkshire Hathaway. So he and my wife Melinda and I are the three trustees. And he (Buffet) recommended that I write an Annual Letter talking about what had gone well what had gone poorly and what people should expect from the Foundation in the years ahead. And Warren has always encouraged us to be very bold in the things we do pick, things that even though might not succeed, that if they do succeed they would have high impact.
Most of you probably know that the two big causes we work on are global health and education. Around global health, as we have expanded over the past 10 years, we have been able to add a lot of work in agriculture financial services and sanitation as well. We are very active in Africa. If you had to categorize our spending, a lot of it is up in research, working on HIV vaccine, TB vaccine, malaria vaccine and all the new tools for the diseases that disproportionately affect Africa in particular. The second category is the actual delivery effort, working with countries to strengthen their primary healthcare systems or the systems they use to support their farmers. And so the work has been very exciting and a lot of good progress has been recorded in areas like the under- five survival rate going up, malaria deaths going down quite. There is a lot still to be done to understand things like death in the first 30 days. So we are doing a lot gathering information from families who give us permission to look at those deaths and understand how we can bring them down because they have not come down as much as others. And understanding things like nutrition, many of the kids who survive don t fully develop mentally and physically and the science of that has not been totally understood.
So a lot of the work now is giving us insight so that hopefully we can substantially reduce malnutrition. We picked ten questions this year that cover quite a range of things and I am glad to elaborate on any of those or answer any other questions you have. Your Foundation has invested so much in developing countries especially in the area of health and development. Have the results met your expectations; if not, what are the gaps? There are two types of gaps in health. One is that we are missing tools that would make a huge difference. And so we need to fund research. In the case of HIV we don’t have a vaccine. We are spending literally hundreds of millions of dollars with many different approaches to try and invent that vaccine. Our Foundation and the U.S. government are the two big funders there. And so tools like that or a malaria vaccine and TB vaccine, there is a big gap because we won’t be able to bring those diseases down until we have the new tools. Then there are gaps in terms of financing existing tools. And that’s why we created, in the case of vaccines, GAVI, the Global Alliance of Vaccines, that buys vaccines at the lowest price and then uses donor money to finance most of the cost. We do ask the recipient countries to pay a small amount. And then if a country’s economy grows enough eventually, they graduate from that. In most areas, the main limiting factor is the quality of the delivery system.
That is, getting things out into the rural areas and having the trained staff there. And the key is not so much the hospital systems for that as it is the primary healthcare system. And so we do a lot of work to help countries improve their primary healthcare system and the practices within it. That’s turned out to be super important. We are doing that not only in Nigeria but also intensely in places like Ethiopia. What would you say to convince billionaires in Nigeria to consider the commonwealth in their country instead of pursuing big (inaudible) [naira] and stashing it offshore? What did it take you to give up a significant portion of your wealth to help people in need? The person we work with the most is Mr. Dangote and I am always amazed how generous he has been both with his resources and his time. Just this week, he and I spent six hours on video conferences with six of the northern states where we twice a year, check in with them and look at their primary healthcare quality in terms of the staff, the location, the supply chain and the results they are getting in terms of vaccination and other interventions. And so, in the entire world, Mr. Dangote has been a very key partner.
And the big challenge of improving the primary healthcare, particularly in the North, I know we would not have a chance of doing that without him. I have had a chance to meet with other Nigerians but, in fact, he is the only one who I am personally aware of his significant activities that is working in this key sector. There may be other people working in sectors like education or other environments that we don’t work in. Whenever I travel, I try to sit down with successful people and encourage them that philanthropy can be a great thing. I was looking over the Nigeria purported list of wealthy people and it was interesting that a number of those seem to be based in London. But I am always interested in suggestions about how we draw more people in. We need lots and lots of partners, particularly if they understand the local issues and how the government works locally. They have credibility and understanding that we don’t have. And so we would love to have more partnerships like we have with Mr. Dangote.
With your large presence in Africa, are you collaborating with any 100 per cent Africa-owned companies, innovative start-ups or actors in the private sector to create efficient solutions in healthcare and other areas that you are working in? There certainly are. The companies we work with have a presence in Africa and there are certainly smaller organizations, profit and non-profit like eHealth in Nigeria, or some of the scientific companies in South Africa. One of the two philanthropists that we work with is Patrice Motsepe in South Africa. Aliko Dangote who has been an incredible partner in Nigeria works with us on things like nutrition and the primary healthcare sector. We have an investment with the World Bank where we gave them $100 million and they created a fund to invest in African healthcare. And we have another fund with Abraaj which is a health fund that we put $100 million in to invest in healthcare assets. In the case of healthcare, it varies from country to country but, at the hospital level, many of the countries that will be for profit type entities and certainly all the supply chain things are going into hospitals.
For things like delivering to primary healthcare, we always encourage countries to use the private sector to do that. But in some cases they feel like that should be done by government employees. So the health sector will have a lot of private participants in it. And we are super supportive of that for the hospital services. We head for the AIDS Conference in Amsterdam in July. I would like you to shed more light on what the Foundation is doing with regard to NCC and kids born by mothers with HIV? HIV is one of the biggest programs at the Foundation. The other two that are very large are malaria and polio. And so we are supporting a wide range of activities to reduce the AIDS epidemic including the mother to child transmission. On advocacy, we are the biggest funder of a thing called One; for bringing in the private sector, we are the biggest funder of a thing called Red. We are by far the biggest supporter of the Global Fund, the non-governmental supporter of the Global Fund and working very closely with Global Fund on their programmes.
There are specific groups that are working on the mother to child that we have funded over time and those numbers have been brought down. It is unfortunate that in a lot of countries it is still not down to zero because if you get the woman and you give the full regimen, which is the full ARV regimen, not just the single drug approach that was used for a long time, the chance of transmission is greatly reduced at the time of delivery. And then there are other tools to try and avoid transmission through breastfeeding. I haven’t looked at how much the numbers have come down this year but I know it is harder to get that down to zero than we expected and Global Fund has that as one of its top priorities because it is in some ways even worse than all the other forms of transmission.
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