THe number of confirmed measles cases in Quebec has risen to 119, according to officials. From the archives, here’s our cover story
Bill Gates is still best known as the co-founder of Microsoft, but, since 2000, when the Bill & Melinda Gates Foundation was launched, the American software billionaire has devoted much of his energy to global development philanthropy. Gates was in Ottawa last week to discuss overseas aid with Prime Minister Stephen Harper, the opposition party leaders, and others. He spoke with Maclean’s just before appearing on stage with Harper—largely to highlight aid to improve the health of mothers and children in poor countries—at an event at the Canadian headquarters of the Aga Khan Foundation.
You’ve been framing 2015 with a certain symmetry: 15 years since you launched your foundation and a 15-year outlook for global development. How will this next phase differ from what’s come before?
We’ve had 15 years to learn, to make a lot of mistakes, to grow in size, to develop expertise, so I’m very excited about the foundation being able to have more impact in the next 15 years than we had in our first 15. I feel very good about what we did in our first 15 years. So it’s kind of fun for Melinda and me to say, “Hey, in the next 15 years, what could we do about nutrition? What could we do about childhood death, so the chance of a kid dying in a poor country isn’t dramatically higher than it is in the U.S. or Canada?”
The goals are pretty achievable because of the progress [of the past 15 years]. Yet the visibility of this arc of progress, the grand statistics of what’s happening with health or literacy or nutrition, there isn’t a broad awareness of those things, because people mostly see the bad news. They certainly saw the Ebola epidemic. If there’s a famine, if there’s an earthquake, they see the negative human condition. The fact that there used to be so many widespread deaths, sort of one at a time, that’s not a headline. So the drastic reductions—cutting the rate of childhood death in half since 1990 . . .
Which is remarkable.
It is remarkable. Of all the statistics of, “Hey, is humanity treating humanity well? Do we feel good about where we are?” that one should be pretty top of mind. Yet it’s a very small group that would even know that.
Still, you’ve said you see potential for the cause of development to turn into a popular movement, to become similar to the feeling in past decades behind the civil rights or anti-apartheid movements. How would that shift happen?
In countries such as the U.S. and Canada, where a lot of people are doing quite well, the question is: Can you take your loyalty and your values and go further than yourself and your family, or even beyond your region and your country? Can you have, as a member of the human race, the idea that you volunteer time or your voice, or whatever means you have to give?
You’re connecting yourself with these improvements: eradicating polio, for example, or making sure there’s enough food for poor children. I think that moral vacuum, where people want to be associated with more than just their own success—they want to have knowledge and a sense of progress that they contributed to—I think that’s pretty gigantic. The question is, in a digital world where you can track things and connect people up, and get more evidence back to them at very low cost: Can we ignite this desire for that connection? We call that our “global citizen” movement.
Connecting to the overall cause is too broad, so some people, ideally, will pick women’s reproductive rights and some will pick agriculture. And then there are NGOs in each of those areas that you can volunteer for, give money to, and feel connected. But that’s not an easy thing. Our challenge is largely that the poorest live far away from those who are well off.
You’ve come to Ottawa to meet with the Prime Minister and others. How does the recent Canadian track record on global development fit with the approach your foundation tries to encourage?
During this 15-year period we talk about, 2000-15, the whole face of foreign aid has changed quite a bit. If you go back to the Cold War era, mostly you gave to friends and you pretended it was going to have some great humanitarian benefit. But largely, it was to cement friendships and the Soviet-vs.-West-type paradigm.
During [the past 15 years], this idea of, “No, let’s really shift the money into the things that are impactful,” that’s caught on quite a bit. And I’d say that Canadian aid, helped a lot by civil-society voices here—[groups such as] Rotary on polio eradication, Save the Children, and people who support UNICEF—Canada has actually been at the forefront of a fairly dramatic shift toward, “Let’s do aid that we know is impactful.”
So Canada and the Gates Foundation have been on a similar journey, and it’s a mix of talking to each other and sharing what we’re learning, but also seeing the same things. The alignment of a substantial amount of the Canadian aid budget with things we’re doing is very high.
Can you give an example of that alignment?
Studying kids’ minds, why they’re not getting full mental development—Canada got out in front of that. The great unseen problem of disease and bad nutrition is actually the kids who survive: In Africa, half the kids who survive never develop physically or mentally. Actually measuring those deficits and understanding what the best interventions are for avoiding that—the field has been very naive about that.
So Canada and the Gates Foundation have probably been the two biggest funders to try to get behind that, and to try to get things aligned behind that. In these countries, becoming self-sufficient, which is the goal, is an important issue.
Among your foundation’s priorities, you list many things most Canadians would recognize as familiar development goals, such as boosting Africa’s agricultural output and improving health care in practical ways. But you also highlight some innovations that might be surprising to many. For instance, can you explain why you see the spread of banking services being provided over cellphones in poor countries as important? Are there cases where that has made a big difference?
Fortunately, like a lot of things we do, we have exemplars where it has worked quite well, such as: Kenya with M-Pesa, or Bangladesh with B-Cash; the ability to move money to your relatives, who are back in the rural areas; the ability to have a savings account that’s even pretty small; and the ability to say, “When I sell my agricultural produce, let me make it a little hard for me to spend the money I should save for seeds and fertilizer for the planting season.”
A lot of things get invented in the rich world, and the price comes down, and then they are available in the poor world. For a lot of things, that works very well. In face-to-face banking, if you are only trying to do transactions of a few dollars, the fees end up being, like, 20 per cent. So banking the way the West has done it doesn’t scale down. Only digital banking scales down.
So the idea is that this digital banking unlocks some free-market economic potential in those countries?
Exactly. It’s to make markets work, so that, instead of buying a cow to hold your savings, you can set it aside on your phone and say, “This is for my kids’ education, this is for my farm reinvestment.” It will be very catalytic, and it only needs to be funded for a three- or four-year period, then it’s self-supporting.
Your foundation is mostly associated with trying to end poverty in the long term, but you’ve been quite involved in responding to the Ebola epidemic in West Africa. Has coming to grips with that emergency changed your thinking at all?
Certainly, we view the Ebola epidemic as being our focus, because we are global health experts. The two biggest funders by far of global health research are the U.S. government, through the National Institutes of Health, [and the Gates Foundation]. We’re a partner in health delivery. Now, as a percentage, we’re a much smaller part of that, but we’re a partner in making sure primary health care systems get built.
The kind of setback Ebola represents is this: Ebola was tragic. Ebola will kill, say, 10,000 to 12,000 people by the time we’re done. But the measles deaths you could have—in three countries with a population of 23 million, if you don’t go in and catch up the vaccination systems that shut down for the past nine months—would be more than Ebola caused directly.
Let me get this straight. The measles deaths resulting from the way the Ebola crisis has interrupted normal vaccination programs will be worse than Ebola itself?
Will be, unless we go in and take all those kids who passed the normal age when they would get measles vaccines, if we don’t get in there. If you let measles vaccines get really low, you get really big spreads. Even the U.S. has seen a tiny taste of that, so we need to do catch-up vaccinations. We know how to do that, but it needs a little extra money, a little extra personnel.
Any other lessons from the Ebola experience?
I have this very positive view of where the world will be in 15 years. If you said, “What clouds are on that horizon?” I think the chance of some nuclear war, some big-nation state war—bigger than [Islamic State]—is modest. There’s the chance of an epidemic that is even slightly more infectious than Ebola that could really spread to lots of poor countries, maybe even coming into rich countries. We saw that the world isn’t that fast-moving.
Even with the SARS outbreak back in 2003, there were serious problems with the response.
Exactly. We’ve had two influenza scares, a SARS scare and an Ebola scare and, even so, the preparedness [remains a problem]. Are the volunteers ready to volunteer? Whose planes should we use? So I’m part of a group in the global health community that’s talking about how we can minimize the chance of some big setback, probably [an epidemic causing] a million excess deaths. A natural disaster doesn’t reach that level. Small wars don’t. But the 1918 Spanish influenza killed more than 50 million globally. It’s not impossible that we’d have something like that, so making sure there’s surveillance, preparedness, research and development—we do view that as something for which we should be part of the response.
I imagine a lot of Canadians, if they consider the philanthropy you’ve thrown yourself into, would say it’s great, but the fundamental solutions in poor countries would involve building governments that have the capacity to set up and run permanent institutions, such as health services and school systems. How do you see the sort of work you’re doing fitting with that model for how progress is ultimately achieved and sustained?
There are really three sectors of society. There’s the private sector: How many Thai restaurants should we have? What toys should we build? The private sector is way, way the best. Then there are things the private sector can’t do: Make sure people get educated, help out with health emergencies. Those things, the government should do. That’s 96 per cent of the economy, those two sectors.
So what is philanthropy about? New approaches, say, to run schools, or a medical research program that has a high risk of failure. Or asking: Are these African governments doing their job? There are a lot of things [government and the private sector] don’t catch. And because philanthropy is so much smaller, it has to pick the things those other two are not appropriate for. It can’t be the thing that guarantees every kid gets an education; there’s just not enough money. But the Rockefeller Foundation helped to fund the Green Revolution. There are enough hits in philanthropic history, so we want philanthropy, and it satisfies people’s desire to be associated with something more than, “Oh, I pay my taxes.”
This is an edited version of the complete interview with Bill Gates. To listen to the full conversation, click below, or subscribe to Maclean’s Voices: