The FP Interview: Bill and Melinda Gates

Bill Gates on what’s lacking in development:
The greatest market failure is the lack of investment in innovation, particularly innovation that would be of particular value to the poorest. We’ve been big on funding disease and agricultural innovations; why governments tend to fund delivery more than they fund upstream innovation, I don’t know. In delivery systems, it wouldn’t be typical for us to take on that kind of funding other than in pilot mode because when you’re talking about delivering incentive payments to an entire country, it’s not something that philanthropic means are going to be able to have the scale to do. But a lot of our inventiveness is on how upstream [innovation] and downstream [delivery] work together. So you take the polio campaign: using satellite maps to update the microplans that the vaccinators follow, using the GPS tracker to follow along to see if the independent monitoring person actually goes and visits the houses that they say they’re visiting so that your tracking data is good. I don’t think a lot of what we’re doing with polio deserves a pure classification of upstream or downstream.

On working with governments on aid:
Within our areas of expertise, which include health and agriculture, some financial services, water, and sanitation, we are willing to really celebrate the great successes where rich-country aid budgets are funding things that are quite successful. We spend over $3 billion a year, of which $2 billion gets spent outside the United States, on these issues of helping the poorest countries. Getting the word out there — [so] that people know that when the U.S is spending on malaria bed nets it’s making a difference; or when Europe is funding new agricultural things, that that’s worked out; or The Global Fund or GAVI Alliance are doing great work — we spent quite a bit of time on that. Certainly at this G20 meeting [in November] we are encouraging rich countries and middle-income countries to spend their aid well and not to reduce their generosity lower than the minimum necessary.

On the complicated global politics of getting new drugs to the right people:
We’ve got to make sure great things get invented and that they get financed and that they get delivered. Take the case of vaccines. A good example of something we did is we worked with the Chinese regulatory authority so that they would get certified as a good regulatory authority so that some of the vaccines in China, including a Japanese encephalitis vaccine, could get out into the marketplace. It’s not like somebody figured out this great world regulatory scheme. So you know, we find cases where it’s not clear what the right path through it is.

On tax schemes to raise more public money for aid:
There’s a financial transaction tax in Hong Kong. There’s one in the UK having to do with securities settlement fees. I think you can design something that raises, say, $10 to $20 billion a year, implemented by a number of countries, that would help in the world of aid well spent. We’re saving lives for a few thousand per life — that’s literally millions of lives that can be saved and countries that can be put on a sustainable path, along with the stability and security and medical benefits to the world at large. Even for the rich countries that are stretched to make their commitments, there are ways that I don’t believe are that damaging that would let them meet, or get close to, their commitments.

On the emerging markets that are surprisingly good partners:
Brazil and China have not been traditional aid givers, but both have a lot to contribute. We just signed an agreement with the Chinese Ministry of Science and Technology about them giving grants to innovators in China whose products can help the poor countries. We also just signed an arrangement with Brazil, where we’re working with Embrapa — that’s their agricultural expertise group that did such miracle work on tropical soils — where we work with them on pilot projects. So you have some new donors that bring new capabilities to help complement what the traditional donors are doing.

Melinda Gates on what they’ve learned:
We learned that if people were able to put aside a little bit of money each day or week — even just a dollar or two — then they had savings to serve as a cushion when things got tough. But there wasn’t a system set up to help them save. We’re really excited about M-Pesa. It’s the first mobile money service that’s become really useful to millions of people.

Behavior change is critical. While we’re working upstream, developing solutions, we’ve got to be thinking about delivery: How should we develop and deliver those solutions so they will be adopted? I visited a project in India last year called Shivgarh. They’ve made incredible progress in behavior change and cut neonatal mortality by more than half in just 15 months. Communities created songs about skin-to-skin care — kangaroo care — and immediate and exclusive breastfeeding and clean-cord care. There are examples like this in other places in South Asia and in several countries in sub-Saharan Africa. Now we have to evaluate these behavior-change successes so that they can be extended to other places.