Ask Bill Gates

Earlier this month NEWSWEEK invited readers to submit questions to Bill Gates about the work his foundation is doing on the problem of global health. We received more than 400 questions, and forwarded a selection of them to Gates. Here are his answers:

How did you start thinking about the Third World, when the whole world has been ignoring them?
—Kumud B.
Melinda and I first got involved in global health after reading an article about the huge impact of disease in poor countries. The article showed that every year millions of children die from diseases that are completely preventable with effective, affordable vaccines. We thought, "This can't be true. But if it is true, it should be the priority of our giving." Since then, Melinda and I have traveled extensively in the developing world, and those experiences have had a big impact too. When you have the opportunity to meet people in poor countries face to face, you quickly begin to see them as neighbors, not strangers. And when you see the devastation of diseases like malaria or AIDS, you want to do all you can to help.

I was born and raised in Mexico. I am now a Ph.D. student [in the U.S.]. I often struggle to find the right balance between working on new and exciting technology and the desire of helping those who need most. I am sure you are aware of several efforts that use high tech to try to solve the world's biggest problems. However, my impression is that, while helpful, they have a smaller impact on the world compared to the use of low-tech solutions, such as vaccination or boiling water to prevent disease. Do you think there are irreconcilable differences between high tech and social development? If not, what are the best approaches to tackle this?
—Andrés
We need both. Millions of lives can be saved if we do a better job of ensuring access to "low tech" health tools that already exist. For example, it's been estimated that 3 million newborn deaths could be prevented every year with greater access to relatively cheap, simple tools like vaccines and antibiotics. That's why some of the Gates Foundation's largest grants are helping to accelerate the delivery of existing solutions. For instance, we have provided $1.5 billion to the GAVI Alliance, which supports children's immunization in poor countries. We have also supported the Carter Center's efforts to distribute low-tech—but highly effective—tools to help eradicate Guinea worm, such as a special straw that filters out fleas from drinking water. But for many of the biggest health problems, the solutions we have today are not adequate. We need more effective and affordable vaccines, drugs, and diagnostic tests for many of the worst diseases, like AIDS, TB, and malaria. That's why we also invest significant resources into research and development.

I have nothing but respect for you and your wife for leading the way in helping to ease the suffering of so many people. [But the] planet is already overpopulated. Is it fair to save lives through advancements in medicine only to subject these people to abject poverty, more illness and the possibility of starvation?
—Judy B.
Melinda and I asked the same question when we got involved in global health, and the answer surprised us: there are good data to show that when health conditions improve, population growth actually goes down. Very quickly people realize that they can have fewer children because there's a much better chance they will grow up to be healthy adults. In countries where health improves, life improves on many levels: literacy rates go up, school attendance increases, economic opportunities grow, and so on.

Your foundation works on diseases caused by poverty. But what about diseases of affluence, like diabetes and obesity and heart disease? Will you work on them? Or do you think those diseases are the victims' own fault?
—Ben P.
All of those issues are important and need more attention. Melinda and I believe our foundation can have the greatest impact by focusing on a limited set of problems. That allows us to build up expertise in our focus areas, and to make long-term investments. Within health, we have decided to focus on about 20 diseases and health problems that disproportionately affect poor countries and receive inadequate attention and resources.

One of the elements that has hindered developmental efforts in the Third World, primarily Africa, has been the endemic culture of corruption that permeates many levels of government and society at large. How does your foundation circumvent this in its programs?
—James K.
This is an important issue—when a government sets the wrong incentives or undermines basic infrastructure and stability, there's a modest amount that outsiders can do. But it's also important not to overstate the problem. Many leaders in developing countries are seriously committed to improving the lives of their people, and they need support.
When our foundation supports projects in developing countries, we partner with organizations that have the expertise and capacity to deliver results on the ground. In many cases our partners have been doing work on these issues for many years, and our support enables them to move with greater urgency and help even more people. We're also committed to rigorously evaluating the results of our efforts, and changing course when we don't get the results we want.