Despite losing $18 billion of his net worth in the financial collapse, Bill Gates remains a self-described "impatient optimist"--about global health, that is. He stepped down as Microsoft CEO in June 2008 to devote more time to the Bill and Melinda Gates Foundation, the largest philanthropic organization in the world. He and his wife, Melinda, met with NEWSWEEK's Jerry Guo in Washington last week before a major speech to policymakers on health programs. Excerpts:
There's been a backlash against the idea that more aid is always better. What do you say to the skeptics?
BILL: Of the countries that donors give aid to, there's a number, like Brazil, Mexico, and Thailand, that have graduated, and what we're left with is a very tough group. But health aid is probably the least controversial because it brings down population growth.
Are you concerned some of the funding you're asking for will end up empowering bad governments?
BILL: A vaccine is not that attractive to a dictator. Even in the toughest countries--Congo, Somalia--vaccinations work. If you're getting into building roads, you may have to stay away.
What is the most pressing health issue facing the developing world?
MELINDA: We have made amazing progress on the deaths of children under 5. But we have not made much progress on deaths in children within the first 30 days of life. Four million babies die every year in the first 30 days, three fourths in the first week. Saving these children would not be that difficult. A lot of it is cultural. We need to educate the mothers.
The HIV vaccine trial held in Thailand this September showed mixed results. How far away are we?
BILL: That was much better news than expected. We want to get vaccines for tuberculosis and malaria, and each of those can take a decade or more. My guess is HIV will be the toughest. We have vaccines for some of the diarrheal diseases and pneumonia that are just rolling out. They will save millions of lives.
But are these efforts sustainable when basic health infrastructure is often lacking? The rotavirus vaccine for diarrhea costs $20 per child. Shouldn't we spend that $20 on cheaper interventions?
BILL: Yes, some of the mosquito biting can be avoided, and that's a great thing. Bed nets are $10. They make the list of miracle interventions. They're heavily used in five countries in Africa that are seeing the greatest reduction in malarial deaths.
How do you feel about the Obama team's emphasis on global health?
BILL: They're putting emphasis on these new vaccines and maternal health, looking to increase these investments. They're facing a big budget deficit, so when they go to Congress, the fact U.S. taxpayers know this category has worked super well will become particularly important.
It seems like an uphill battle.
BILL: It speaks to our value of equality. It speaks to our belief that preserving the environment is important, by making sure there is not severe overpopulation. The tools that we have now are better than ever. Think of children's lives saved, going from the 20 million that died per year in the 1960s to the fewer than 9 million today, to the goal of fewer than 5 million deaths within 15 years. That's a pretty appealing story when you're talking about a quarter of a percent of the federal budget.
What is one surprising thing you've learned while traveling for this campaign?
MELINDA: It surprises me that people still sheepishly ask us, "But won't this lead to overpopulation?" Women will naturally have fewer children if they know their kids have a greater chance of survival. Knowing that is really key.