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BBC Radio Hard Talk Interviews Bill Gates

Publication Date: 2011-05-24

BBC Radio's Hard Talk travels to Geneva, currently hosting the World Health Assembly, to meet the world's most influential philanthropist, Bill Gates. The founder of Microsoft is currently reckoned to be the world's second richest man. His Gates Foundation spends roughly three billion dollars a year on global health and development projects. His drive and vision transformed the world of computing, but what kind of a difference can he really make in the global fight against disease and child mortality?

Stephen Sackur is the Hard Talk interviewer.


Microsoft no longer is synonymous with tech's tomorrow; Google, Facebook and Apple are. Flops like the Zune music player add to the sense that, for all its strengths, Microsoft is a dinosaur. The vast majority of its profit comes from Windows and Office. While neither attained dominance by being shoddy, they are cash cows rather than bywords for growth and innovation. For that, see cloud computing--which is a more competitive environment--and smartphones or tablet devices, where Microsoft is a follower.
--Liam Denning, Wall Street Journal, 5/18/11
A BBC Radio Hard Talk interview reveals Bill Gates exhibiting an interesting pattern of not actually answering questions but instead speaking to the talking points he is determined to make. In particular, he ignores deep concerns--such as whether he has any business getting into the creation of new seeds. . . or better bananas.
Better Bananas, Nicer Mosquitos New York Times
6 December 2005
by Donald G. McNeil Jr.

...Addressing 275 of the world's most brilliant scientists, Bill Gates cracked a joke:

"I've been applying my imagination to the synergies of this," he said. "We could have sorghum that cures latent tuberculosis. We could have mosquitoes that spread vitamin A. And most important, we could have bananas that never need to be kept cold."

They laughed. Perhaps that was to be expected when the world's richest man, who had just promised them $450 million, was delivering a punchline. But it was also germane, because they were gathered to celebrate some of the oddest-sounding projects in the history of science.
Some people are very worried about a number of Bill Gates' projects. As noted in the Lancet articles below, they wonder who is in on the decision-making process that launches these projects. The Lancet editorial asks the question our media--and our professional publications--refuse to ask: For such a large and influential investor in global health, is such a whimsical governance principle good enough? Whose advice has the Foundation taken in devising its strategy?

The BBC program focus--Gates Foundation funding of medical and seed research--touches certain concerns of the Foundation's education funding and gives the listener a glimpse of Bill Gates' arrogance. And speaking of personality and mosquitoes, here's a first-hand description of what Bill Gates did with a jar of mosquitoes at the TED conference.[Warning: profanity used]

NOTE: This snippet from the BBC interview is not a transcript but as close as I could come to transcribing a small portion. Since Lancet criticism is mentioned, Lancet articles are posted below.

Question: Are we in danger of overestimating the difference philanthropy can make? Bill es, Welcome. You've applied an awful lot of money and brainpower in the effort to eradicate some of the world's most dangerous diseases. Is is fair to say it's proving perhaps harder than you expected?

Gates: Actually most of our focus is reducing childhood death... so there's a lot of success here.

Question: The Decade of the Vaccines. . . . When one looks at your efforts to find vaccines that will really work against malaria, against HIV AIDS, I come back to this point that it is extraordinarily difficult, isn't it?

Gates: First thing, we want to get the vaccines that rich kids take all the time and get them to the poorest kids who suffer 100 times as much from these diseases. . . We've brought a lot of energy and brilliant minds to these vaccine inventions... I'm very optimistic....

Question: I'm intrigued by your life in tech. . . pushing the boundaries. . . and now your life in the technology of public health. . . . Some time ago you suggested that thermal stable vaccines were 'very close.' But despite all the money you've put into R & D, it hasn't happened. Why?

Gates: Actually we didn't put too much into that, because the complexity of getting everything reapproved would be very tough . . . Using science to make things work. . . critically. . . .

Question: Have you ever pondered some of the potential dangers of the massive philanthropic activity you're undertaking? . . .

Gates: That less children will die?

Question: No that wouldn't be the downside. But first of all, the basic lack of accountability. You are a private foundation. . . . and second, you are doing some of the work that ought to be done that maybe would be best done by government. . . .

Gates:...The idea that there's a better seed for the farmer--that's just a tool. . . There are things that just fall between the cracks. . . .

Question: The Lancet magazine looked very closely at what you did. . . and had a lot of praise said that some of what you did was whimsical, pet projects that you were particularly interested in. They suggested need for outside voices on your board. . . Did you pay any heed to that?

Gates: The projects we pick have a very clear criteria--the diseases that kill the most children. . . . We're trying to drive at very high speeds. So there is a difference between us and very large committees. . . . We have a bias toward action. The kind of dialogue created by that Lancet article, we welcome.

Question: [asked about Gates' developing "a better banana."]

Gates: Whenever you create a new drug or a new seed, it's very important that every country have a regulatory process that says do the benefits outweigh the possible problems. . . Seed approval is never in the hands of anybody but a sovereign entity.

Question: Has the scale of your wealth. . . made you uncomfortable?

Gates: Benefits come with wealth. . . I feel that I'm a very lucky man. . . getting to do what I do. . . .

Question: Do you ever think, This is ridiculous. This is too much? I actually don't want to be the world's wealthiest man.

Gates: If I hadn't given money to my foundation, I'd still have to deal with that. . . .

Question: Is it painful for you to watch Microsoft to lose its innovative, field-leading edge?

Gates: Microsoft is doing a lot of great work. . . .

Question:. . . The phone, the Tablet, the hand-held revolution, Microsoft has been left behind.

Gates: Oh, I wouldn't say that. . . . It's software approaches. . . The idea that reading is now moving. . .

The Lancet, Volume 373, Issue 9675, Page 1577, 9 May 2009

What has the Gates Foundation done for global health?


The answer to this question is: a great deal, but...

The massive boost to global health funding that the Bill & Melinda Gates Foundation has given since its inception in 1994 is astonishing. The Foundation's current expenditure of around US$3 billion annually has challenged the world to think big and to be more ambitious about what can be done to save lives in low-income settings. The Gates Foundation has added renewed dynamism, credibility, and attractiveness to global health. In particular, the Foundation inaugurated an important new era of scientific commitment to global health predicaments. For example, other more well-established funding organisations--such as the US National Institutes of Healthâ€"now take their international health responsibilities far more seriously thanks to the Foundation's energetic advocacy. Perhaps even more important is the fresh and deep political commitment to health that the Foundation has fostered.

There are several big successes the Foundation can take credit for. The Global Alliance for Vaccines and Immunisation, which received an initial gift from the Foundation of $750 million in 1999, has been its single most important contribution to global health so far. To that we would add the Foundation's investment in the Seattle-based Institute for Health Metrics and Evaluation, which, in its short life, has made a critical impact on international policy and thinking, acting as a valuable independent scientific monitor of global programmes in health.

But apart from questions over its investments, the Gates Foundation has received little external scrutiny. Last year, Devi Sridhar and Rajaie Batniji reported that the Foundation gave most of its grants to organisations in high-income countries. There was a heavy bias in its funding towards malaria and HIV/AIDS, with relatively little investment into tuberculosis, maternal and child health, and nutritionâ€"with chronic diseases being entirely absent from its spending portfolio. In The Lancet today, David McCoy and colleagues extend these findings by evaluating the grants allocated by the Gates Foundation from 1998â€"2007. Their study shows even more robustly that the grants made by the Foundation do not reflect the burden of disease endured by those in deepest poverty. In an accompanying Comment, Robert Black and colleagues discuss the alarmingly poor correlation between the Foundation's funding and childhood disease priorities.

The concern expressed to us by many scientists who have long worked in low-income settings is that important health programmes are being distorted by large grants from the Gates Foundation. For example, a focus on malaria in areas where other diseases cause more human harm creates damaging perverse incentives for politicians, policy makers, and health workers. In some countries, the valuable resources of the Foundation are being wasted and diverted from more urgent needs.

There is also a serious anxiety about the transparency of the Foundation's operation. What are the Foundation's future plans? It is hard to know for sure. The first guiding principle of the Foundation is that it is "driven by the interests and passions of the Gates family". An annual letter from Bill Gates summarises those passions, referring to newspaper articles, books, and chance events that have shaped the Foundation's strategy. For such a large and influential investor in global health, is such a whimsical governance principle good enough? Whose advice has the Foundation taken in devising its strategy? {emphasis added] Sadly, the Foundation has acquired a reputation for not always listening to its friends. Although it is driven by the belief that “all lives have equal value”, it seems that the Foundation does not believe that every voice has equal value, especially voices from those it seeks most to assist.

We have five modest proposals for the Gates Foundation. First, improve your governance. Visibly involve diverse leaders with experience in global health in your strategic and operational stewardship. Second, be more transparent and accountable in your decision making. Explain your strategy openly and change it in the light of advice and evidence. Third, devise a grant award plan that more accurately reflects the global burden of disease, aligning yourself more with the needs of those in greatest suffering. Fourth, do more to invest in health systems and research capacity in low-income countries, leaving a sustainable footprint of your commitment. Finally, listen and be prepared to engage with your friends. The Lancet was sorry that the Foundation declined our invitation to respond to the paper by McCoy and colleagues, and to set out its vision for their role in global health.

The Gates Foundation says that it is “open to amending” its principles as it grows and learns more about its work. Now is an inflection point in the Foundation's history, a moment when change is necessary.

The Lancet, Volume 373, Issue 9675, Pages 1645 - 1653, 9 May 2009

The Bill & Melinda Gates Foundation's grant-making programme for global health

by David McCoy

Summary The Bill & Melinda Gates Foundation is a major contributor to global health; its influence on international health policy and the design of global health programmes and initiatives is profound. Although the foundation's contribution to global health generally receives acclaim, fairly little is known about its grant-making programme. We undertook an analysis of 1094 global health grants awarded between January, 1998, and December, 2007. We found that the total value of these grants was US$8·95 billion, of which $5·82 billion (65%) was shared by only 20 organisations. Nevertheless, a wide range of global health organisations, such as WHO, the GAVI Alliance, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, prominent universities, and non-governmental organisations received grants. $3·62 billion (40% of all funding) was given to supranational organisations. Of the remaining amount, 82% went to recipients based in the USA. Just over a third ($3·27 billion) of funding was allocated to research and development (mainly for vaccines and microbicides), or to basic science research. The findings of this report raise several questions about the foundation's global health grant-making programme, which needs further research and assessment.

The Bill & Melinda Gates Foundation (henceforth referred to as the Gates Foundation) is the largest private grant-making foundation in the world.1 It has three main programmes: a US programme that focuses on secondary and post-secondary education; a global development programme that focuses on hunger and poverty (with an emphasis on small farmers and financial services for the poor); and a global health programme. The total amount paid out by the foundation for all grants in 2007 was US$2·01 billion, of which $1·22 billion (61%) was for global health.2

Although there is a long history of private philanthropic funding in global healthâ€"notably by the Rockefeller Foundation and the Ford Foundationâ€"the influence of the Gates Foundation is of a different order. In 2007, the amount spent by the Gates Foundation on global health was almost as much as WHO's annual budget (approximately $1·65 billion),3 and was substantially more than the total grant spending of the Rockefeller Foundation across all programmatic areas in the same year ($0·17 billion).4 The Gates Foundation's effect on global health is evident in malaria research. In the late 1990s, only $84 million was spent on malaria research yearly; since 2000, the Gates Foundation has helped to roughly treble this amount.5 However, there have been concerns about the role, effect, and lack of accountability6â€"8 of the Gates Foundation (and of private foundations in general9, 10). So far, the foundation's global health programme has not been properly assessed. In this report, therefore, we describe and discuss the foundation's grant-making programme for global health. Although we do not assess the impact or cost-effectiveness of the programme, this analysis provides a useful starting point.

We used information published on the Gates Foundation and Grand Challenges in Global Health websites to identify all global health grants awarded by the foundation from January, 1998, to December, 2007. For each grant, we entered the name of the primary recipient, the size and length of the grant, and a brief description of the grant (as found on the websites) into a Microsoft Excel spreadsheet.

After we had completed an initial analysis, the Gates Foundation changed the way in which it organised grants information on its website; we discovered several previously unidentified grants and several grants for which the financial value had changed. We also noticed that a small number of previously identified grants had disappeared from the website. We therefore reconstructed the database and undertook a second analysis. We kept the missing grants in our database on the assumption that they had inadvertently been omitted when the website was redesigned. We also excluded several duplicate grants that had been listed on both the Grand Challenges in Global Health and Gates Foundation websites.

We classified each grant according to four variables and a set of categories as shown in the panel. This process was not straightforward for three main reasons. First, many grants could be placed in more than one categoryâ€"for example, they might cover both research and service delivery, or cut across more than one disease or health issue. We therefore classified several grants according to more than one category. Second, we were unable to generate a set of discrete, non-overlapping categories. For example, there is unavoidable overlap between categories such as child health and vaccines, between programme and policy development and scientific meetings and conferences, and between sexual and reproductive health and HIV/AIDS. There were also ambiguities about the categorisation of organisations with, for example, some organisations containing both non-profit and for-profit components, or being part government and part non-government. Third, the description of many grants was brief and sometimes vague. The descriptions of grants to support health programmes, for example, were not always clear about the extent to which they focused on clinical as opposed to public health activities, nor the extent to which they included a research component. Often, it was necessary to look for additional information on the website of the grant recipient, or to make an educated guess based on the grant description or knowledge of the recipient. Finally, an important limitation of this study is that we only gathered data for the value of the grant as specified on the websites and not on the amount actually disbursed to or spent by recipients.

[The rest of the article is available free of charge here.

The Lancet, Volume 360, Issue 9346, Page 1617, 23 November 2002

Philanthropist or commercial opportunist?


Bill Gates, chairman and chief software architect of Microsoft, and co-founder of the Bill & Melinda Gates Foundation, courted controversy last week while mixing business with philanthropy and by publicly endorsing a US government report predicting an AIDS epidemic in India. The report, issued by the US National Intelligence Council in September, 2002, predicts that India will have 20â€"25 million cases of HIV/AIDS by 2010â€"the highest estimate for any country in the world. Official Indian government statistics state that 4 million adults currently have HIV/AIDS, but the report states “expert estimates” of the real figure as between 5 and 8 million. Heterosexual transmission is the main driver of HIV infection, except in two regions (Nagaland and Manipur) where intravenous drug use is widespread. Between 30% and 60% of prostitutes and up to 15% of truck drivers are infected with HIV/AIDS in India. The report accuses the Indian government of a failure to give HIV/AIDS the sustained high priority that has been the key to stemming the tide of the disease in other countries such as Uganda, Thailand, and Brazil. Inadequate health services, the cost of education and treatment programmes, other demands on health resources such as tuberculosis, the social stigma attached to HIV/AIDS, and the cultural and moral traditions and values in India will all contribute to the rapid rise in HIV/AIDS prevalence, states the NIC report.

Writing in The New York Times on Nov 9, Gates states that much of India's progress towards becoming a global economic superpower will be threatened by AIDS. Quoting the NIC report's projected HIV/AIDS prevalence figures, Gates says that there is still time to prevent a widespread AIDS epidemic in India. "The humanitarian imperative for action is undeniable. But there are other reasons for the West to be concerned about India's future", says Gates, adding "With one of the largest scientific and technical work forces in the world, it is also an increasingly important business partner for many countries...India's rapidly growing software sector has made the country a critical partner to many American companies, including Microsoft."

On Monday, Nov 11, during a visit to India, Bill Gates announced that the Bill & Melinda Gates Foundation will give the Indian government an initial US$100 million to tackle HIV/AIDS. This generous donation is to be used to expand access to proven HIV prevention strategies among mobile populations, to combat societal stigma surrounding the disease, and to increase awareness and leadership on HIV/AIDS. Both the press release issued by the Bill & Melinda Gates Foundation and Gates' own article in The New York Times quote the NIC report's projected HIV/AIDS prevalence figures for India. However, the Indian Health Minister, who will chair the board that will manage the Foundation's programme, has publicly disagreed with these projected figures (see Lancet Nov 16, p 1576), describing them as "completely inaccurate". On Tuesday, Nov 12, wearing his Microsoft hat, Gates announced the company's largest investment outside the USA. At a press conference in Hyderabad, home of Microsoft's research centre in India, Gates said that Microsoft will be putting US$400 million over 3 years into product development, software testing, and education and business partnerships in India, so enhancing the company's presence. Gates announced that the investment would enable Indian businesses to exploit Microsoft's .NET tools, such as by developing software for financial service companies, a rapidly growing market segment in India. The .NET platform, anti-piracy technology, and new database technologies are part of Microsoft's research portfolio, aimed at extending the company's reach despite the threat from potential competitors, including open-source operating systems such as Linux.

Philanthropy and commerce can make uneasy bedfellows. The "humanitarian imperative" of the AIDS epidemic in India is clear, as documented in the NIC report, but so are the investment opportunities for Microsoft in India. Having just emerged from a 5-year antitrust lawsuit in the USA, and with the European Commission about to rule on its investigation into the company's practices, could Microsoft benefit from Bill Gates being seen as a responsible industry leader? By acting as spokesman both for his Foundation and Microsoft, cynics may feel that Gates has distracted attention from the very problem that his Foundation is, rightly, trying to address--the impending HIV/AIDS epidemic in India.

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