NOW with Bill Moyers; 219; Bill Moyers talks with Bill Gates

You Tonight on now with Bill Moyers, Bill Gates Jr. talks with Bill Moyers about health and wealth. You were clearly competent at making money. Did you doubt your competence in giving it away?

I actually thought that it would be a little confusing during the same period of your life to be in one meeting where you're trying to make money and then go to another meeting where you're giving it away. I mean, is it going to erode your ability to make money? Are you going to somehow get confused about what you're trying to do? It's a very nice confusion. So, you know, I didn't want to mix those two things together. The big milestone event for me, though, was a report was done, it's called the World Development Report 1993, that talked about these diseases. And I remember seeing the article in it and it showed that rotavirus kills over a half million children per year. And I said to myself, that can't be true. You know, after all, the newspaper, whenever there's a plane crashing and 100 people die, they always report that, how can it be that this disease that's killing the happening here? I've never seen an article about it until now. And it wasn't even an article about that.

It was just a graph that had, you know, these 12 diseases that kill most of which I had never heard of. It was a crisis in global health, using high-tech and new knowledge to fight deadly disease. All that, tonight on now with Bill Moyers, the Weekly News Magazine from PBS. Funding for now has been provided by our sole corporate funder. For over 50 years, we've put retirement and pension products to work for those in a public service. Now we're doing the same for the rest of America, mutual of America, for all of America, the spirit of America. And by the John D. and Catherine T. MacArthur Foundation, the Colbert Foundation, the Nathan Cummings Foundation, the John S. and James L. Knight Foundation, the Park Foundation, and by contributions to your PBS station from viewers like you. Thank you.

From our studios in New York, Bill Moyers. Welcome to now, tonight a departure from our usual format to focus on one very vital subject and one very wealthy man. Most of us know about Bill Gates, how he went from a drop-out at Harvard to the founder of the software giant Microsoft to the richest man in the world. At one point, earning an estimated average of $4.5 million an hour. What is not so well known is that Bill Gates has decided to give his money away. Most of it, that is. Through the Bill and Melinda Gates Foundation, he's taken on the challenge of global health, especially among the poorest of the poor. It may surprise you to learn that only 10 percent of medical research is dedicated to diseases that cause 90 percent of the world's health problems. Bill Gates is trying to close that gap. Global health, of course, is suddenly on everybody's mind. Right now, the world has been focused on the outbreak of SARS, severe acute respiratory syndrome. It reminds us just how quickly a mysterious epidemic can spread across the planet.

But whether SARS burns out, remains, or mutates into some other deadly strain, this issue remains. At many of the most catastrophic diseases are in the poorest parts of the world, invisible to the rest of us. That's the wake-up call Bill Gates wants us to answer, as you'll hear in just a few minutes. First, this report by my colleague, producer Brian Myers. Okay. You're going to go right up here. Patients are a little more worried these days when they come into traveler's medical service in New York City. The clinic provides vaccinations to tourist and business people, headed to exotic destinations overseas. Are you taking into consideration the current SARS situation in that part of the world, particularly China? It seems like only yesterday that war and terrorism were the traveler's biggest concerns. Now it's the outbreak of SARS, the deadly respiratory virus that appeared suddenly in China and spread like wildfire throughout eastern Asia. There has been a fair amount of concern among people that tend to travel to that region, particularly among the business community.

Many corporations have ceased travel to the region completely. Fears of an epidemic spread even faster than the virus itself. The airport in Hong Kong was deserted, so was this normally crowded market in Toronto. In some cities, there's been a run on masks. SARS became big news to lead story day after day. SARS, the new disease that is fast becoming one of the most international health officials alert of the world about SARS. There's a virulent and mysterious virus called SARS. But while doctors say people going abroad should take SARS seriously, they also urge clients not to panic. It's really important for people to keep SARS in perspective mainly because there are so many other illnesses that statistically people are likely to get when they travel if they don't take the proper precautions. While there have been around 7,000 cases of SARS worldwide and about 500 deaths, public health officials have moved swiftly to contain the epidemic. Just a few hundred cases have been reported in North America.

And in Hong Kong, new infections are slowing. Just this past Tuesday, the head of the World Health Organization held out hope that SARS can be eliminated altogether. The epidemic has been a wake up call. It's reminded us of a crucial fact. A strong public health response can make a huge difference in the face of a deadly disease. But lost in all the headlines is another fact. Hundreds of millions of people still suffer from diseases that remain invisible to us. Take malaria, for instance. Two weeks ago, the United Nations released this report. Three hundred million people fall ill to malaria each year. More than one million of them die. Yet with all the commotion over SARS, that report barely made the evening news. Well, I think that's a usual and perhaps understandable human response that something that's new and threatening does get attention. Nonetheless, as Dr. David Brandling Bennett, SARS has served to remind us of the continuing challenge of global health. He's a top official at the Pan American Health Organization, an arm of the UN's World Health Organization.

Dr. Brandling Bennett calls illnesses like malaria, measles, and tuberculosis the forgotten diseases. Although they longer go cease to be a big problem here in America, they continue to be chronic killers in the third world. The things that are happening routinely, which may be of much larger magnitude, of course we tend to ignore or become accustomed to, unfortunately, complacency is what we call it. AIDS is one third world killer that has made its way to the United States. But even with AIDS, there's a difference. Easier access in America to treatments and preventive measures have kept AIDS from exploding the way it has in the third world. Poor countries where AIDS is epidemic, says Dr. Brandling Bennett, should have access to similar help. Many of these diseases, the effort really depends upon slogging it out and a lot of hard work, not on a highly sophisticated technology. What it takes are health care workers, armed with low-cost drugs.

Consider these figures from the World Health Organization. A tablet of the most popular anti-malarial medicine calls just 12 cents. A measles vaccine, 26 cents. A six-month course of treatment for TB, as little as $10. And a year's supply of condoms to prevent the transmission of HIV, $14. We're not talking about a huge sum of money. Girl Bellamy runs UNICEF, the United Nations Children's Song. For years, UNICEF has been taking on the big global killer. Malaria is the number one killer of children in Africa, 3000 children dying every day, one every three minutes. It is a preventable disease. It doesn't require some five-star hospital. With malaria, it's a race against time, a new strain of malaria that is resistant to the most popular treatment that 12 cent tablet is on the increase in Africa. That really signaled the appearance of a very serious problem because we would no longer be able to treat children simply with a very safe and very cheap drug.

Besides that 12 cent pill, there are other malaria drugs that work, but they cost more, or more toxic, and sometimes more difficult to use. Worse, if these more expensive drugs should prove ineffective, doctors like Bradley Bennett may be out of treatment options. The imperative is that the situation is more likely to get worse than it is better. For example, with malaria, we don't have another generation of drugs waiting to come online. The fact is, there is little demand, major demand, in the richer or the industrialized countries, for the remedies that are necessary to respond to these kinds of diseases that are found in so many of the poor countries. That's reflected in the budgets of the big American drug companies. In the year 2000, they spent $21 billion on research and development, but only 13% of that went to infective and parasitic diseases. Because of that, both UNICEF and the WHO are also pushing non-pharmaceutical solutions for diseases like malaria.

Bed netting treated with insecticide to repel malaria mosquitoes has proven both effective and cheap, the nets cost around $4 each. Diaria is another crippler that doesn't need a drug to solve. You may be surprised to learn that one and a half million children die each year from diarrhea, and illness most of us consider nothing more than a nuisance. In the poorest countries, if there's no simple intervention, they become dehydrated, they are not taken care of well, they don't have adequate nutrition, and they die. The solution to water-borne illnesses like diarrhea can be as simple as a new village well. So if treating and preventing such diseases can be so simple and so cheap, why are so many people still dying across the third world? Certainly an after-corrupt government in these countries can be an obstacle, but says Carol Bellamy of UNICEF, the big industrialized nations have not made attacking these diseases a big enough priority. It means that foreign assistance needs to still be invested in health care, good health care and good education.

If you know what to do, and you know that by doing it, you can save lives, it's really time to do it. It's hard to come up with an overall price tag on what it would cost to launch and all-out effort to rid the third world of major diseases. But if past experiences in the gut, it's not an impossible task. Meet Luis Cortez. This is Luis in 1994 at age 3. Luis was the very last case of polio recorded in all of North and South America. Polio, once one of the world's most dreaded diseases, eradicated in the western hemisphere through an ambitious immunization program. And in what's considered nothing less than a milestone in public health, another of history's great plagues, smallpox, has been eradicated worldwide. Once again, an immunization program worked. And what did that program cost? Just $325 million.

We were talking about relatively a low-tech enterprise. Most of the money was spent on employing local people who could track down the disease and people who had been exposed and make sure they got vaccinated. With governments on their own failing to cope with the public health challenge, non-profit organization to try to fill the gap, one of them is the Bill and Melinda Gates Foundation. Funded by the Microsoft Computer Fortune, it is one of the richest foundations in the world, with assets of over $20 billion. Gates' father, Bill Gates' senior, runs the foundation. Mr. Gates is the Irene Abago. Last year, we accompanied Bill Gates' senior and former President Jimmy Carter as they traveled to Africa for a firsthand look at the worst epidemic of all, AIDS. And if you take all the wars put together in the history of humankind, there's never been such a devastating cost in human lives as is resulting from HIV AIDS. Of the 40 million people in the world with HIV, 70% of them live in sub-Saharan Africa,

3 million died of HIV AIDS worldwide each year. For Gates and Carter, this trip is a fact-finding mission. In Nigeria, they, along with Mrs. Carter, gather information from a group of prostitutes who face the threat of AIDS. Have any of you seen someone dying of AIDS? I've seen anybody dying of AIDS. In my hometown, there are more than 200 people like a mixture. Unprotected sex with prostitutes is one reason why HIV and AIDS are so widespread in Africa. The men who are their customers travel home, spreading the disease from village to village. Someday, last week, a month slapped me. Why? Because I take him to use condoms. How busy they are at the level of their activity and how many customers? I have 15 people. 15 or 10 people in a day. My own case, the most important thing is to deliberate about what the foundation can do

further than it already is about this problem. And to speak out, to speak out to our government, to our Congress, to our public, about the importance of the United States stepping up, the United States has to step up. That's Bill Gates, senior talking. And his better-known son has been making the case too. Speaking about why the Family Foundation gives a billion dollars a year to try to close the gap between rich and poor. Recently, the younger Gates came to the Columbia University's Mailman School of Public Health to talk about the subject. I interviewed him, surrounded by public health students and faculty. When I first heard that you were going to give away billions of dollars to global health, I was skeptical. I mean, no one could doubt that you know everything there is to know about information technology, but global health. And I thought, here's a man surrounded by power and privilege, whose every need and every comfort are met.

How could he possibly see the world through the eyes of an impoverished woman with HIV in India, or a hungry, starving child in Mozambique? How could he possibly get inside of their way of seeing the world so that what he did wasn't just a rich man's hobby? Certainly, I'll never be able to put myself in the situation that people growing up in the less developed countries are in. I've gotten a bit of a sense of it by being out there and meeting people and talking to them. And one of the gentlemen I met with AIDS talked about how he'd been kicked out of where he'd lived and how he'd felt awful that he'd given it to his wife. And they're struggled to make sure that their child didn't have it. And the whole stigma thing, which, you know, that's hard to appreciate. In this country when you get sick, people generally reach out.

That's a time to help other people. And yet some of these diseases, it's quite the opposite. So when I was thinking about where my resources that I'm the steward of, be able to make an impact, I thought, okay, what's the greatest inequity left? And to me, and the more I learned about health and the unbelievable inequity, it kind of stunned me. It shocked me every step of the way. You could have chosen any field, any subject, any issue, and poured billions into it and been celebrated. How did you come to this one, to global health? You know, the two areas that are changing in this amazing way are information technology and medical technology. Those are the things that the world will be very different 20 years from now than it is today. And I'm so excited about those advances. And they actually feed off of each other. The medical world uses the information tools to do their work. And so when you have those advances, you think, will they be available to everyone?

Will they not just be for the rich world, or even just the rich people in the rich world? Will they be for the world at large? The one issue that really grabbed me as urgent was issues related to population, reproductive health. And maybe the most interesting thing I learned is this thing that is still surprising when I tell other people, which is that as you improve health in a society, population growth goes down. You know, I thought it was, before I learned about it, I thought it was paradoxical. Well, if you improve health, aren't you just do mean people to deal with such a lack of resources, where they won't be educated, or they won't have enough food, you know, sort of a malthusian view of what would take place. And the fact that health leads parents to decide, okay, we don't need to have as many children, because the chance of having the less children being able to survive to be adults and take care of us, means we don't have to have seven or eight children.

You know, that was amazing. But did you come to reproductive issues as an intellectual philosophical pursuit, or was there something that happened, did you come up on, was there a revelation? Well, I was growing up. My parents were always involved in various volunteer things. My dad was head of plant parenthood. And it was very controversial to be involved with that. And so I was fascinated that the dinner table and my parents were very good at sharing the things that they were doing, and almost treating us like adults, talking about that. My mom was on the United Way group that decides how to allocate the money and looks at all the different charities and makes the very hard decisions about where that pool of funds is going to go. So I always knew there was something about really educating people and giving them choices in terms of family size. I have to say I got off the track when I started Microsoft. I thought, OK, now I have my passion, at least for the next 40 years or so.

And when my mom said to me, oh, you have to do a United Way campaign. I said to my mom, this is serious stuff now. That was all nice to talk about. But, you know, I've got to pay these people. And if we don't get enough contracts, and this is a very competitive environment. So this whole notion that we're going to sit around and drink tea into the United Way campaigns. I don't think we have time for that. But she kept working on me and saying, no, this is a good thing and had me meet with other people. So finally, I thought, OK, I'll fit it into my framework, which is getting the employees to kind of feel more bonded, more of a team, and appreciate the unique position they're in. And so we made United Way fun. We had contests around it. We had the agencies come in. But a little bit, I had drifted away from thinking about these philanthropic things. And it was only as the wealth got large enough.

And Melinda and I had talked about the view that that wealth wasn't something that would be good to just pass to the children because, you know, wealth of any kind of magnitude like that. It's actually more, I haven't asked them their opinion yet, but more of a handicap than it is of a benefit. So, you know, once you decide that, that over 95% of it's going back to society, then you do start talking about where will it go on. So Melinda and I were having those conversations. But we only had one or two projects that we thought we'd get into early. We thought, OK, this is mostly, you know, for many decades from now. You were clearly competent at making money. Did you doubt your competence in giving it away? I actually thought that it would be a little confusing during the same period of your life to be in one meeting where you're trying to make money.

And then go to another meeting where you're giving it away. I mean, is it going to erode your ability, you know, to make money? Are you going to somehow get confused about what you're trying to do? It's a very nice confusion. And so, you know, I didn't want to mix those two things together. The big milestone event for me, though, was a report was done, it's called the World Development Report 1993, that talked about these diseases. And I remember seeing the article in it and it showed that road of virus kills over a half million children per year. And I said to myself, that can't be true. You know, after all, the newspaper, whenever there's a plane crashing and a hundred people die, they always report that, how can it be that this disease that's killing a half million a year? I've never seen an article about it until now. And it wasn't even an article about that. It was just a graph that had, you know, these 12 diseases that kill most of which I had never heard of. And so I thought, this is bizarre.

Why isn't it being covered? You know, and there's a mother and a father behind every one of these deaths that are dealing with that tragedy. And so then I got drawn in a little bit. And there was one dinner after we'd given our first vaccination grant. I think it was 125 million. All these doctors came. And they thought, okay, this is a dinner where I'm supposed to just say, thank you. Thank you. And, you know, try not to use the wrong fork or something. So they're there and, you know, it's a nice dinner. But after about 50 minutes, I say to them, yeah, well, it's like, okay, you thank me enough. But what would you do if you had more money? And they're all kind of like, well, does he really mean that? Is he serious? I said, yeah, what if you had, you know, ten times as much money? What would you do? And then the guy who's worked his whole life on hepatitis B speaks up. And the guy who's working on AIDS speaks up. And the guy who's working on pneumococcal speaks up. And so it started opening the door to saying, you know, there's a,

it's sort of a bad news story in that governments are not giving the money. Their treating human life is being worth a few hundred dollars in the world at large. And that's in almost a factor of a thousand difference between how it's treated in the world versus in the, in the, the rest of the world. Oscar Wilde once said that it's the mark of a truly educated man. And I'm sure you would today say, woman, it's the mark of a truly educated man to be deeply moved by statistics. What is that capacity that enables someone to transform a fact or a figure on a page to a human being a long way off? What is it? I think there is a, a general difficulty of looking at a number and having it have the same impact as, as meeting a person. I mean, if we said right now, there's somebody in the next room who's dying. Let's all go save their life.

You know, everybody would just get up immediately and go get involved in that. When my daughter who's seven saw this video, you know, showing the, the kid who's got the difficulty walking because of polio, you know, her reaction was, who is that? Where are they? Let's go help them. Let's go meet, meet that kid. What if he gets polio in his other leg? You know, so she's immediately drawn in to that human on the screen. So it's, it's a lot easier to connect to the story of the one person or the five people. It, now, you know, because I'm mathematically literate, you know, I know that when there's three million kids every year, dying of things that are completely preventable with technology we have today, you know, I, I can try and magnify how I feel about that one situation by a factor of three million. It's tough, but at least you know it's super important.

What does it say to you that half of all 15-year-olds in South Africa and Broadway could lose their lives to AIDS? What does it say to you that 11 million children roughly die every year from preventable diseases? What does it say to you that of the four million babies who are, who die within their first month, 98 percent are from poor countries? What do those statistics tell you about the world? It really is a failure of capitalism. You know, capitalism is this wonderful thing that motivates people. It causes wonderful inventions to be done. But in this area of diseases of the world at large, it's really let us down. But markets are supposed to deliver goods and services to people. And when people have money, it does. You know, when our foundation is not involved in the diseases of the rich world, not, you know, those are very important, but the market is working there between the basic research that the government funds through NIH, the biotech companies, the pharmaceutical companies, you know,

incredible things will happen with cancer and heart disease over these next 20 or 30 years. Because that's a case where capitalism is at work. There's a profit at it. There's a profit at it. Right. Here what we have is with the poor world diseases. It's not only don't the people with money have the disease, but they don't see the people who have the disease. If we took the world and we just reassorted each neighborhood to be randomly mixed up, then this whole thing would get solved. Because you'd look out your window and you'd say, you know, there's a mother over there whose child is dying. You know, let's go help that person. This problem, the lack of visibility, it's partly you don't read about it, you don't see it. It's the silence that's allowing this to happen. Was there an aha moment, was there a moment of Eureka when you realized what you're just saying and said, this is where we're going to put our billions? I know when I saw that article on the World Development Report,

I said, this can't be true, but if it is true, this deserves to be the priority of our giving. And so I took the article and Melinda read it, I gave it to my dad and said, can you have the people who are working with, tell me is this some aberration here? If this is true, give me more things to read. So it was a shock, but then it was an answer to say that governments weren't doing it, and so maybe we could help step in. And maybe not just our resources, but maybe we could galvanize some interest and attention and IQ to go and look at these problems and think, if I have the technology that can stop mosquitoes from carrying these diseases or allow vaccines to be delivered without a refrigerator,

I have saved millions of lives by coming up with those ideas. I talked on Saturday to one of the leading public health officials in the world, one of the pioneers in this field. And he said, you want to ask him for a list of books, and he provided you with a list of books. And the next time he had seen you just a few months later, you'd read 17 of them. I mean, do you ever read anything for fun? You ever read your emails? There was about six months where I was carrying around about 10 issues of the morbidity and mortality weekly report. And people would see that on my desk at work, and what the heck? You're reading the morbidity and mortality weekly report. You know, I'd say to him, yeah, here's this one from the 1980s when AIDS came out. This is real collector's item. Here, actually, it's taken a lot of different books to get the different perspectives and try and understand what could be done. It's one thing to read a book. It's one thing to read a statistic.

One thing to read a graph. It's another thing to read a human being's face. Did you go into the field? Yes, I, it's awkward. I'm not, you know, particularly good at this. Maybe I'll never be good at it, but to walk around to each patient and ask, you know, what is your problem and be respectful of, you know, their desire for privacy. But I think it is very important. If people got out like that, you know, these problems would get addressed. There was a trip you took to Soweto in South Africa that was decisive in your thinking. Tell me about that. Well, we took a computer and we took it to this community center in Soweto. And generally, there wasn't power in that community center. But they'd rigged up this thing where the, the cord went like 200 yards to this place where there was a generator, you know, powered by diesel. And so this computer got turned on. And, you know, when the press was there, it was all working just fine. And it was ludicrous, you know, that it was clear to me that the priority issues

for the people who lived there in that particular community were more related to health than they were to having that computer. And so there's certainly a role for getting computers out there. But when you look at the, say, the two billion of the six billion on the planet who are living on the least income, you know, they deserve a chance. And that chance can only be given by improving the health conditions. The thing that's so stark is that you're in Johannesburg, which is sort of a first world location, you know, you're talking with banks about their software. And, you know, it's, you feel like, it's not that much different than being in the United States. And then you drive about five miles and you're in one of the, the most poor areas you've ever been in. You know, those houses that are built out of the corrugated arm, which, you know, in the heat, you know, it's just unbearable. And it's very jarring to go from this experience in the city

and to this other experience and have them be so close together, you think, well, how come it's so different in such a small distance? What is your answer to? How it is that the resources of the world are so misallocated? It's a mistake. But somebody has to make a mistake. Who makes it? I think we make it every day by thinking that national borders are, you know, allow huge inequities to exist across those borders. And I do think this next century hopefully will be about a more global view, where you don't just think he has my country is doing well, but you think about the world at large. There is one excuse that people have for not paying attention to this. It's not a valid excuse, but... And that is that things have been improving despite the research money not being applied the right way. Infant mortality or life expectancy,

even in the countries in the worst situation, infant mortality is lower today than it was in the best country 120 years ago. Now, there are things that come along like the AIDS epidemic that send it in the other direction. And we shouldn't be willing to wait, you know, and have it take 50 or 100 years for these medicines, the new vaccines, that kind of treatment to be widespread. Have you made any progress on safe birth reproductive family planning issues? Yes, it's a... There's a measurable impact when you can go in and educate families, but primarily women about their different choices. There's real impact that you can have in this area. Anything to do with reproductive health, whether it's maternal mortality, infant mortality, there's new ideas, there's more people getting involved. One of my colleagues that accompanied your father

and Jimmy Carter, when they went to Africa not long ago, the footage was striking. There was your father and Jimmy Carter, former President of the United States, sitting on the doorstep, talking about condoms as if you were talking about computers. Are you comfortable dealing that openly with people's habits, people's behavior? Well, it's interesting. The AIDS is as disease that is hard to talk about. That visit that my dad did, the health minister had never been in that neighborhood, and so they invited him to come, and people didn't think he would, but he actually did come, and then got involved and said, okay, we're going to do free condom distribution to this neighborhood because of the impact that that can have. Someone told me, actually, a couple of weeks ago, that we'd actually be better off if you'd spend more money on distributing condoms. They don't, this research on AIDS at the moment, that it's the immediate need that people have to, you know, about their behavior, that is the biggest problem the world faces with AIDS.

What do you think about that? The ideal thing would be to have a 100% effective AIDS vaccine and to have broad usage of that vaccine. That would literally break the epidemic. Because that, it's not known how long that'll take, and the best case is probably in a 10 to 15-year time frame, we also have to put huge energy into treatment of the people who have it today. We've got to put a lot of money into changing behavior, which we've funded a number of things in that. And there's even an intermediate intervention that we think is very important, which is I'm a crowbicide. Oh, what? I'm a crowbicide. That's a gel that a woman could use to block sexual transmission without the male even knowing that it's being used, ideally. That requires a great discipline of passion and the question that arises.

You know how to motivate your Microsoft employees. You know how to affect their behavior by the rewards that you hold out. How does the world affect the behavior of people at a sexual level? That's a very tough problem. It's particularly tough if political leaders aren't willing to speak out. There's been really just a few countries where the politician said, this is so important for the welfare of our citizens. And even though it involves drug use and sex workers, they were going to get up and say that it was a crisis for the country. That happened in Thailand. That's the only country that really caught the potential epidemic at the early stage. It happened that you've gone, and you've gone a bit, it happened after the disease had already progressed to about a 20% prevalence. It's not happening to the degree it should in other countries. And anyone who thinks it's confined to Africa

is going to get quite a wake-up call that in already in India, there's between 5 and 10 million people who have AIDS. And it's only a question of how many tens of millions or perhaps more than 100 million people in India will get this disease. And yet intervening early is when you can have the biggest effect. I interviewed Dr. David Holi a couple of weeks ago. He's made the great research breakthrough at Times Man of the Year for it. He's now worried about China. Where his forebearers came from. I was in China just two weeks ago, talking to the health minister and talking to Xinjiang men about raising the profile there. And they have a, for their level of income, quite a strong health system, and quite a willingness to say, okay, if this is about sex workers, we'll go in and we'll register the sex workers and we'll make sure that certain behavioral changes are taking place, like Thailand did.

And so I think the right thing will happen there. They will need international support. They'll need more encouragement to make sure it gets done. What do you think about the Bush administration's retreat from women's health issues, reproductive rights around the world? Not only their retreat from it, but their outright opposition and their effort to impede it. You know, we've got to make sure that those that money really gets allocated and we've got to make sure it gets used effectively. But they're not supporting contraception. They're not supporting condom distribution. They're not supporting safe sex. Part of the problem is that the, the citizenry doesn't speak up enough and make it a big issue. You mean make it make global health a grassroots issue? That's right. And yet if you, if you grab so many and say, do you care about this thing? You can engage them very quickly, but it's not on the agenda. How do we do that? Well, I'm, I'm thinking a lot about that. I'm, I'm interested in any ideas. Because this is about human welfare. You know, this, how we deal with the AIDS epidemic

should be one of the greatest ways that the world gets measured. The report card for this era, these next few decades. A big part of that grade should be, did we apply all of the world's resources and activities and visibility against the AIDS crisis? And yet, to the average voter, you know, they, it's not on the radar screen. That there's only about six dollars a year being given to world health issues by the US. And we're, we're quite a lager than our giving. You know, we have to go out and regalitize people that the role of the United States is not just what we do in the area of security. It's also sharing our advances in our resources. And if somebody wants to think about the chance of terrorism in the decades ahead, I think this issue of how young people outside the US think of our country. What is the role of the US in terms of creating opportunity for them? And if we don't step up to these health issues,

you know, we're really not answering that critical issue. What would you like the average American to know about global health? I think understanding the basic facts about the AIDS epidemic is important. I think knowing how little resources are going into these things, knowing that this is not a case of government waste. I mean, there's this notion of government spending in general and foreign aid that it often ends up in some dictators bank account. In the area of world health, we're actually coming into the country with vaccines and you're working at the village level to measure coverage there. We can be very effective. This is not money that 20 years from now, we're going to wake up and say, how was that money spent? We'll know how it was spent, because we look at the stopping the disease progression. And so it is a special thing that the cynicism about government spending should be suspended here

because it can be handled in the right way. In this country, we have eliminated diphtheria and whooping cough and all of those childhood diseases that were still prevalent when I was a kid many years ago. The vaccines exist, but we do not get them to the people whose lives, the children whose lives would be saved right now if they had them. Why don't they get to the people, the kids who need them? Well, the biggest single initiative we've done is the vaccine fund. And that was 750 million to galvanize the world to say, okay, let's enter a new phase where we raise vaccination coverage from a little bit less than 70% it is today. And we get the new vaccines in there. You know, the hepatitis B pneumococcal. There's about four that we have here in the U.S. that are not being given worldwide. The total cost of getting vaccines, the package to a child is about $30. And even if we add in the new vaccines,

we'd still be less than 50 dollars of cost for this delivery. And so that money, which was supplemented to some decree by governments and others, but not as much as we had hoped, is very directly related to this vaccination coverage. What do you think are the major diseases that we're going to have to deal with in the next 25 years? Well, top of the list is certainly AIDS. It's very epidemic. And I don't think it's even recognized how bad the epidemic could become. If you were going to design a bad disease, you probably couldn't do something worse than AIDS. The latency, the fact that you're infected and you don't actually see the health effects till six to eight years later, that causes people not to understand what's going on. Take something like smoking. Say that instead of dying 30 years later of cancer that instead you just dropped dead right then.

People would get the connection. He smoked, he died. That's not good. That's not smoke anymore. Well, AIDS is like that, where you just don't see the impact on a society. If people after, you know, some visiting a sex worker walked out and they just fell on the street, you know, there'd be a pile of bodies there and you'd say, okay, something's going on here. The fact that there's these little epidemics of hemorrhagic fevers, they get incredible publicity, Ebola, Marburg, Lossa, you know, and it's literally in the hundreds of people. But because it's all of a sudden that they die, that gets more visibility, almost than AIDS gets. You know, playing crashes in India and the same day the playing crash, 8,000 kids died of things that could have been prevented. Which gets the coverage? Well, you don't expect coverage every day, but maybe at least once a month,

they ought to just say, by the way, every day this month, we don't want you to forget, just two paragraphs. You know, 8,000 people were dying every day and we'll let you know when it changes, but so far it's been that case for a long, long time. Is it true that in Africa, where children die, respiratory illnesses, than people die of AIDS? Because of this latency, 5 million people were infected this year. And so AIDS will be number one in terms of the cause of death. Infant mortality is still higher. And the biggest piece of infant mortality is acute respiratory infection, generally pneumonia-related diseases. And so they both should be dealt with. In fact, there are vaccines, although they're still very expensive, that can deal with the respiratory problems of infants. Are you looking for a vaccine for malaria? Because malaria kills a lot of people. Yeah, in terms of what's number two, you'd probably put malaria.

Malaria not only kills a million people of year, but at any time, there's 300 million people who are being debilitated by the disease. And if you took the top 10 diseases that are really troublesome in Africa, a lot of them, you wouldn't know the names of. I mean, you know, life's maniasis, just osomiasis. Even something like tracoma that wouldn't make the top 20. It's you get an infection in your eye, and you start itching, and it's the leading cause of preventable blindness, because eventually you itch, and your eye turns in, and you lose your sight. And yet, you know, zythromax is this antibiotic that if you give it, actually can prevent the disease. And if you get enough people taking it, then you stop the spread of that disease. And yet it doesn't, it wouldn't make the top 20. You think that we'll find a vaccine to malaria. Some people say it's impossible. Absolutely. Such a complex disease. No doubt. You know, a personal ominoptumus.

So I should explain that. But with malaria, there is a innate immunity. That is, if you get the disease, you are, it's very, except for different strains. You don't get it again. And so the immune system clearly does recognize something in the course of that disease. And so all we have to do is take the sequencing information and try and find out what that is. And I'd say quite, certainly within the next 20 years, and ideally in the next 10, we'll have a good vaccine for malaria. In business, the market kicks you in the pants if you make a mistake. In philanthropy, some of your mistakes are celebrated because you gave the money and nobody ever came back to ask what happened. We have to be really brutal with ourselves on this. We don't make mistakes. But then again, you've got to take risks. I mean, that's one of the things that philanthropists can do that governments aren't as well-suited to do.

A politician doesn't want to allocate money. If it's a one out of three chance of doing something really good, because then two out of three they'll have to stand up and say it was a waste. Whereas that philanthropist can say, okay, we will take that risk because the payoff would be there, and you know, I'm not going to get voted out of office if in fact it's a dead end. So we should be doing the things that the normal approaches can't do, whether it's approaches to the AIDS vaccine or malaria or delivery systems. We've got to be out there and accept some kind of failure rate. Is the basic problem that we don't have enough knowledge to solve global health issues? Or is it poverty? I mean, if I'm forced to live on one dollar a day, I'm not going to be able to afford any medical care. I'm not going to be able to afford an aspirin. I'm not going to be able to afford to make that trip to that clinic.

Your children, my children, my grandchildren, we can afford, they can afford decent medical care. Isn't poverty the real issue here? It shouldn't be. They benefit to the world, both on a humanitarian basis. But even on a pure economic basis of dealing with these diseases, it's quite clear and quite positive. I actually get angry when people try to justify these health things in economic terms. Like you'll read a paper that says, if malaria was cured, the GMP of this country would be 30% higher. That gets it so backwards. I mean, it's true. Statistically, it's true. And I suppose there are some audiences that you've got to use that argument. But the whole wealth is a tool to measure human welfare. It's just a tool that we created to help us sort of incentivize people and help get things done. If death doesn't get reflected in GMP, then that doesn't mean it's unimportant. If the suffering in malaria doesn't get reflected in those numbers, it's still very important.

So we shouldn't have to resort to these economic arguments. Some people resort to security arguments. They say, if we don't cure these diseases, the instability in these countries will be bad. That could be scary. Or they resort to the, it's coming to your neighborhood argument that somebody could get on a plane from one of these places and you might get sick. I mean, don't worry about these people, but you might get sick. And those arguments, if they get more money for world health, then fine, I won't object. But they're wrong. The right argument is, you know, this mother's child is sick. And that child's life is no less valuable than the life of anyone else. And the world has plenty of resources to go solve these problems. Let's say that everybody agreed with you that they wanted to do the moral thing. What practically could we do? You've already admitted the market doesn't get there.

It doesn't get to Uganda. It doesn't get to Nepal. It doesn't get to Mozambique. It doesn't get to places where people, as you and I talk, are dying from malaria, tuberculosis, AIDS, all kinds of diseases. The market doesn't do it. What, how do we do it? Every, you know, $27 billion is a lot of money, I think. But it's a drop in the bucket compared to what you've been describing. So what do we do practically? For the U.S. to do its fair share, we'd have to take the six dollars per citizen that is spent on foreign health issues. And we'd have to raise that to $30 to $40. And if other rich countries did their part, then there would be the money to give the vaccines, to create the new vaccines, to give oral rehydration therapy, to have the education in the villages. And then the whole picture of health would change quite dramatically. Public health doctors, I know, talk about the positive feedback loop. In poor countries,

if parents believe their children will get better, they save more. And they reproduce less. Therefore, there's more money for other things. Do you think you accept that as a workable theory? Absolutely. And that is the most amazing fact that should be widely known. Essentially, mouthless was wrong. If you raise wealth and you improve health, particularly if you educate women, then this virtuous cycle kicks in in a society not only becomes self-sustaining, but it can move up to a fully developed status. The club of Rome was writing about how we were basically headed towards a disaster, that the amount of food that the world would produce would be inadequate. And the things would just get worse and worse and worse. Well, now, at least in the countries where health has taken a hold, we're seeing literacy rates improve, we're seeing everything about life improved. Once you get this one thing right.

And that was something that was quite a revelation to me. I'd frankly thought that the Malthusian and the principal supplied at least in the developing countries. But because of computer technology, now, medical advances will move at an incredible pace. The next 20 or 30 years will be the time to be in medicine. Many of the tough problems. I'd say most of the tough problems will make huge advances against. Just think about a kid who's curious, say, about malaria. They can go on to the internet today and see what's going on. They can even see the genome if they want. They can see the papers that have been published by different labs. So I get very excited about how the generation that's coming into health right now, the visibility, particularly of these poor-world diseases, and the information now is in their hands, and they ought to be able to do quite a bit with it. Our website at pbs.org offers more insight and information

on the global health issues we've discussed tonight, with links to many other helpful resources. There's data on government health spending, on the relationship between the environment and human health, on the world's most dangerous diseases, and much, much more. That's at pbs.org. In my conversation with Bill Gates, we touched briefly on the topic of women's reproductive rights. It's a very important and, as ever, controversial issue here and around the world. On next week's edition of now, we'll investigate. There is a serious and very well-orchestrated effort that is underway right now to completely take them, take the reproductive freedom away from women, and I think everyone is living in denial saying it will never happen. Until next week, that's it for now. I'm Bill Moyers. Good night.

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