Bill Gates: Behind Microsoft, Money, Malaria

by Forbes Staff

  There are pieces, like some of the research, like the malaria vaccine piece, where philanthropy actually can fund a very substantial, even the majority of that. But when you get into the delivery mode, the $130 billion a year of government aid budgets focused on these poor countries, making sure that gets used the right way, that it’s not being cut because of budget problems and that you’re drawing in the power of the private sector that’s developing these countries—that’s part of how you’re going to win and get that number to drop in half in the next 15 years.

  Corruption is such a big part of it. How do you make sure that the money you put into these countries isn’t just propping up bad governments?

  Gates: Well, it depends on how measurable the sector you’re operating in is. In the case of health, figuring out how many people survived by getting HIV drugs is pretty straightforward. Figuring out your vaccine coverage that reduces measles, that’s down from over a million a year to $300,000 a year. That is one of the most straightforward things. And because you buy the vaccines and ship them into the country, you know you’re controlling that procurement piece—you have a little bit of training money, a little bit of labor money, maybe a few percent of that can go astray.

  But it’s not like building a road, when you send money to the government and no road shows up, or you know you’re paying twice as much for it. The health and agricultural sectors, which are very critical to the poorest—getting the health right, the nutrition right—those things actually you can operate in a mode where at most corruption would be 5%, and if you can’t withstand a few percent, like someone who came to the training session, then you’re an idealist who really doesn’t belong in the game of helping poor countries.

  Bono: There’s a cure for that disease of corruption. There’s a vaccine, at least. We call it transparency. One of the things we’ve been working on in the ONE Campaign, and have been working on with the support of Bill and Melinda Gates, is a revolution. A transparency revolution. This wave of transparency is coming through all manners of commerce, just bringing daylight so that people can see what’s going on in those transactions and judge for themselves if their governments are dealing with them fairly.

  Hand in hand with transparency, of course, are numbers. Bono, you recently have come out of the closet: You’ve admitted you’re a numbers geek. Talk a bit about “factivism.”

  Bono: Well, that’s just me pretending to be Bill. I’m Irish; we do emotion very well. You’re just experiencing some of it, and it can go on and on and on! I’ve learned to be an evidence-based activist, to cut through the crap, find out what works and find out what doesn’t work. Repeat what works, increase it and stop doing what doesn’t work. I don’t come from a hippie tradition of let’s-all-hold-hands and the world’s going to be a better place. My thing’s much more punk rock.

  I enjoy the math, actually. The math is incredible! I was telling people recently there are 9 million people on AIDS medication. In 2003 there were 50,000. This is the most extraordinary thing. I just want to give thanks to the taxpayers who are paying for that. Because this is a remarkable thing. Numbers work. In the last 10 years infant mortality is down. I think it’s 7,256 less deaths a day. That’s down from 9.4 million to 7.2, something like that. I love these numbers. These are sexy numbers. They rhyme somewhere in my head.

  OK, so based on numbers and data, what’s the biggest course change either of you made?

  Gates: You’re always learning—field visits, meeting with scientists, looking at the numbers; it’s a collage of those things that come together. For our health work, it’s been figuring out how primary health care systems can be really well run—and that gets you the vaccine coverage, it teaches the mother about things to do before birth and after birth, the nutrition things, the reproductive health supplies. It’s amazing how some countries spend very little on their primary health care system and they get 95% of the kids vaccinated, and some spend a lot more and get 30% vaccinated. So the importance of personnel systems and helping get those right, the measurement, training, hiring.

  In our U.S. education work, it’s been the most dramatic where we’ve been focused on school structure in the first four years and not so much on helping the teachers learn from the very, very good teachers. And that shifted around, because we saw about 10% or 15% improvements with the thing we called the small schools initiative—that just wasn’t going to be enough. So we got very focused on how do teachers get feedback, what are the exemplars doing right, can you help people improve—essentially, their personnel system and not just the compensation piece, because that turns out to be secondary to the idea of professional development, analysis and measurement. It’s kind of obvious at this point, but it took a lot of time and money to have that be a primary model that we apply.

  Bono: Applying transparency to development, actually, was a big lesson for us. It’s strange, but the two parties most important in the transaction that we call development assistance are the two sides of the equation who know the least about it. The taxpayer and the child who’s been vaccinated or the student who sits in a class. That has got to change. And I think it will be wonderful when it does.

  I remember, for instance, we worked on debt cancelation, and we were in a ghetto outside of Accra. There were no latrines for, whatever it was, 80,000 people living there. And years later, after fighting for debt cancelation and having this money well spent by the Ghanaian government, I saw the latrines! I was like, “Wow, I have to use these!” I went in, if you’ll excuse me, and I’m standing there and I look up on the wall, and it says “Paid for by HIPC.” HIPC. What’s HIPC? Well, I’ll tell you what HIPC is. HIPC was the U.N.’s idea for Heavily Indebted Poor Countries Initiative. And they were largely leading the vanguard on this debt cancelation. But that was their signage! Does anyone know what that was?

  In the Oval Office with President Bush before the AIDS initiative, I remember saying to him, “You can paint those pills red, white and blue if you have to, Mr. President. If you do this, this will be the best advertisement for the United States ever.” And it has been.

  If this rock thing doesn’t work out, I’m sure K Street has a job for you. I know you come from a family of salesmen—you’ve become maybe the most effective lobbyist in the world. How have you embraced that?

  Bono: Well, thank you. It’s the ideas that win the day, and when we go for a meeting with Angela Merkel, say, a couple of months ago or together, me and Bill, went to see pretty much most of the French government a few months ago, we tried to bring ideas with us that will solve the problem that we are presenting. Our strategy, you could call it sort of inside-game maneuvering with those ideas—but then outside mobilization, so there’s always a moment where you can lean in with the policymaker and just say, if they are being rude to you: “Coming to a stadium near you …”

  Last question. There’s a lot of pressure on you guys, as people expect big things. Do your amazing first acts create self-imposed pressure for your second acts?

  Gates: Well, yes. But that’s fun. You have the possibility to fail. I think Warren’s generosity to the foundation made that even more acute, because if it’s money that you made yourself, it’s like “OK, I have a right to make a mistake.” With his money, even though he’s been nice enough to say it’s OK to fail, I don’t feel like I should. It’s kind of fun. You want to wake up in the morning thinking, “Am I working hard enough? Am I thinking hard enough? Have I found the right people? Why isn’t this thing that I thought would go well not going well?” That’s kind of a dynamic thing, and I feel glad that that kind of challenge—philanthropy has that every bit as much as my previous work did.

  Bono: I haven’t left my day job yet, though there’s always this possibility when U2 puts out an album that no one will be there to buy it. And according to my band, if I keep doing these type of events, that’s going to be closer than we thought. I have a tricky one, you know, because I have to balance being an artist, which is my gift, and being th
is salesperson. In U2, I sell melodies, I sell songs. Here I try to sell ideas, but I have to believe in them, and then I’m a pretty good salesman. There is a huge pressure in not wanting to screw up the position that you’ve been put in. I do feel that, and I know that everyone in ONE feels that and everyone in RED feels that, because we’re serving. Though Nelson Mandela asked us to serve and Desmond Tutu threatened us on a regular basis that if we stop serving we wouldn’t go to heaven, the pressure is internal, as Bill says.

  In this kind of work you do see people crack under that because these are matters of life and death a lot of the time. So it’s lucky that we get to, Bill and myself, drink heavily. That’s a joke. But we actually do have a lot of fun doing this. It’s very exciting to see the progress that’s been made in the last 10 years. And you get to hang out with Warren Buffett, who is a comedian.