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Address by Bill Gates, Co-Chair of the Bill and Melinda Gates Foundation

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Speaker: AusAID

Well, thank you for that excellent introduction. It's a great honour to be here at the National Press Club and to have you host the event. And I'm really pleased to be back in Australia. It was about 18 months ago my family took a three-week vacation here and of course we were overwhelmed by the great beauty and diversity of this country.

Now of course my wife and I, though, work a lot, we're very committed to the work of the foundation, so we took a few days off from our vacation to travel up to Cairns to learn about a pretty amazing piece of research that our foundation is funding. This is us up there. We're doing something you might not expect, we're actually releasing mosquitoes, and these are mosquitoes that normally spread a disease called dengue fever. It's a terrible disease that's actually growing in prevalence and it's a huge concern. In fact, it infects over 100 million people in almost 100 countries each year. And so the question is: how can we stop it?

Well, the person on your left there is Scott O'Neill, and he's a professor at Monash University and he's got a big idea about how to stop dengue. He found out that if you infect these mosquitoes with a bacteria called Wolbachia, then they're unable to transmit the disease. And in fact, this infection, if it's done properly, is passed generation to generation. And so in fact, if you get some of the males and some of the females infected, over time the percentage with this Wolbachia, and therefore the percentage that can't spread the disease will go up and up, and block over time dengue transmission.

So it's a kind of brilliant innovation, and here we are helping him with his field trials. This is the one of the first that he's run. Since that time he's gotten the go ahead to do a big field trial up in Vietnam. And we support him through a program we call the Gates Grand Challenges in Global Health. We wrote down about 20 big challenges that need to be solved, including getting mosquitoes not to transmit diseases. And the world's best scientists applied, and his institution won that.

We believe this idea will work for dengue. We believe that it also can be adopted to the slightly different type of mosquitoes, the Anopheles that transmits malaria. And so although there's risk in this type of work, you have to be patient, we initially funded this now over eight years ago, there's great promise that if we back innovators like this, we can improve global health in a very dramatic way, now, just one example of Australia's excellent record in global health and agriculture research and development. There are many other discoveries in the pipeline. One is a single-dose medicine for malaria. You just take the pill once and you're cured. That would be a huge thing. A test that would detect TB that's very inexpensive, and some new sorghum seeds that are fairly magical in that they can still survive and grow even when there's very little water, so drought resistant sorghum.

And I've chosen that these causes are the ones that we'll put all the foundation's resources behind. And so I'm very pleased that Australia's also been very generous and made a commitment to continue to grow its development assistance while making sure that that assistance is spent in the best way possible.

Here's the graph showing us how that generosity has come up. As you can see, a good increase, even as the Budget's been tough, still an increase, progress towards this 0.5 per cent. It's very important because there are countries like Australia that have continued to be generous to the poor even as global economic conditions have been very tough. A number of countries like Norway, Sweden, Britain, Korea, have joined you in increasing this generosity and increasing the focus on the effectiveness.

If we look at this as a percentage of gross national income, which is the standard measure this is done, you can see Australia measures up fairly well. Not at the very highest, but definitely making progress. In fact, this goes all the way back to 2005 when Prime Minister John Howard announced that Australia would double its aid program over a five-year period and, of course, Prime Minister Gillard and former Prime Minister Rudd also built on that commitment putting you on a path to this 0.5 per cent. What the chart shows - you can't see the numbers very well I don't think, is that you're at 0.37 per cent. Up at the very top in white are shown the countries that are at 0.7 and above, and those are countries like Norway, Sweden, Denmark that have been contributing at those levels for a long, long time and that's kind of an aspiration that the world and in particular many European countries have to get to the 0.7.

But getting to 0.5 would be an increase of 50 per cent from where you are today and that would be measured in terms of lives saved by more AIDS drugs, by more bed nets, getting more farmers the seeds that they need to be able to grow enough to feed their children, and this is the kind of impact that I'm lucky enough to get to go out and see as part of the foundation's work. In fact, I think if we could get people out to see the impact of these programs, they would all be committed both with their own resources and government resources to see that these increases continued. So I was pleased to hear that the bipartisan support for this 0.5 per cent continues, because the example and the leadership is very, very critical.

People often ask why I've changed my career from the work at Microsoft to this focus on the foundation and in particular our primary cause which is giving to health and development. Obviously I loved my work at Microsoft. It was thrilling - at age 13 I got exposed to computers, saw that they were magical, heard that the micro processor chip would be improving exponentially and so almost arbitrary computer power would be available to people on an individual basis, today not just as a personal computer, but even on a cell phone.

And I devoted myself to creating a company that would participate in building the software that would bring that capability to life, that would give us all a tool to communicate and create in new and different ways, and that digital revolution is literally just at the beginning. It's very exciting and, in fact, the tools of that revolution will be valuable as we're training health care workers, as we're getting information about agriculture out to the poorest.

But when I chose to change and focus on the foundation, I saw that technology doesn't naturally get to those most in need and, in fact, that their most basic needs are not initially related to IT or the digital revolution in any way. In fact, the needs are based on wanting their children to live, wanting their child to have nutrition, to grow up to achieve their potential.

In fact, 15 years ago, my wife Melinda and I read an article about a disease called Rotavirus, and it was killing over a million children a year. And it was weird because we'd never heard of Rotavirus. In fact, what we found out was there was a vaccine for Rotavirus that was being given to the children of the rich who had almost no chance of dying from that disease, and yet the poorest in the world who had significant risk, in fact over a million dying, were not getting access to that vaccine. And that kind of stunned us and made us think okay, something needs to be done about this.

In fact, we went back and did some research. In fact, it was it was an Australian researcher named Ruth Bishop and her colleagues at the Royal Children's Hospital in Melbourne who first discovered this back in 1973. And so Rotavirus is one of the main causes of diarrhoea, about 40 per cent of the cases - is a very terrible thing. And so we made it one of our key goals that we would make sure that Rotavirus vaccine got out to all the children in the world and that nobody was denied that vaccine. In fact, the world is making progress on this. We're not there yet, but within five years as the price of that vaccine has come down, as better delivery systems have been created, we will finally achieve that goal and none of those children who died of Rotavirus will have to do so in the future.

So we took that as a central objective, but we learned more about malaria and pneumonia and other things and saw that the science was not being funded and that the delivery was not being funded at the levels that we'd expect. To some degree, it was because these problems were invisible. If we took the poorest of the world and the rest of the world and mixed them together after all, these people would be your neighbours and the outcry to do something would be very gigantic. So it's actually unfortunate that the poor countries of Asia and Africa are all kind of grouped together and if we're not careful, if we don't raise our attention, we may lose sight of the fact of what those people need. And so that's become the primary focus of the work of the foundation.

There are three key principles about smart aid. The first is that people should know that aid really has made a difference, that things are massively improving. It's too easy to think okay the poor countries have always been poor. In fact, they're nothing like they were 50 years ago or 20 years ago or even 10 years ago. You know, I believe very much in being numerical in measuring results, you know, at Microsoft every meeting was about data, proving one technique worked better than another, and - so there are many metrics that show us the progress, that show us when things are working.

I think one of the most important metrics, is the metric that tracks childhood deaths. And so here we see how that's changed over time and what you see is about in the time period I was born in, over 20 million children a year were dying, and yet today when we have well over twice as many children being born, so that number at the same rate would have gone up to 40 million, in fact it's less than seven million. So why is that? Well, the answer is it's due to the generosity of aid and the inventions of vaccines. Over half of that reduction is due to things like the measles vaccine or in the extreme case, the smallpox vaccine. Smallpox by 1980 was completely eradicated because that vaccine was used.

So in the sense of looking at a report card for humanity and saying, are we making progress? Should - is there something here that's unbelievable that we should do more of? I think this kind of stands out as exhibit A. It is our report card because after all, all lives have equal value. So anyone who says that aid doesn't have impact, that claim just does not stand up to scrutiny whatsoever and you'd see the same story if you looked at poverty, literacy, maternal death, this same really dramatic improvement is taking place across all those measures.

The second principle about smart aid is that it's not just purely about the humanitarian benefit. It can be justified on that alone, but it's also good for the world at large. If you think about stability in the world, aid will be critical there. For Australia, 18 of your closest neighbours are developing countries, and so in some ways the imminent neighbourhood where some of these tough challenges are still very, very big are close at hand. And whether it's regional issues or economic opportunity, the solutions of these problems will make improvements that will benefit Australians and the entire world. As noted in an open letter this month from 35 Australian business leaders to the Prime Minister and to the Opposition leader, they said, aid promotes national security and stability and contributes to a more resilient global economy, a growing private sector and stronger emerging markets. So it's certainly the case when you've got, you know, malaria, those things aren't possible and as you eradicate malaria that becomes very possible.

It's been interesting to take one case, which is Korea, which was a huge recipient of aid back in the 1960s even into the early '70s getting UNICEF grants to feed their children. They're the country that's gone all the way from being an aid recipient to being a now very generous aid donor. Now there are many other countries, China probably jumps out as the foremost example, that were an aid recipient and now have made the transition where they're no longer an aid recipient. So we're able to focus the dollars we have on those countries most in need. And, in fact, that over time is beneficial, because aid does make countries self-sufficient whether it's Brazil or Mexico or Thailand, or even over time Indonesia and India. If you take a 10-15 year timeframe, it's very reasonable to see that they will graduate from aid. In fact, aid as a percentage of their budgets has come down very dramatically and a lot of the benefit of aid can be measured from the expertise and the independent voice that comes along with it, not just the percentage increase in financial resources that are made available.

The final principle for smart aid is that some kinds are more effective than others. As we look and praise foreign aid, and look at it in terms of numbers, you know, we should certainly note the fact that some aid is very, very catalytic. And when you give aid you always have to decide what the purpose is. Certainly over 30 years ago when the United States gave aid to Mobutu in Zaire, nobody was thinking that was going to change the lives of children, it was not given for humanitarian benefit. And the mixed purposes for aid sometimes confused this issue. Fortunately no longer is aid given nearly as much for friendship. You know, we don't have Cold War alliances, where at least somebody's our bad guy if we give them enough money.

And so aid - the quality of aid has improved dramatically over the last 20 years as it's become focussed on measurable humanitarian outcomes and that's the aid that makes sense. A good example of this is health aid broadly and some specific multilateral groups that have been pulled together in the last decade. For example, the Global Fund to Fight AIDS, Tuberculosis and Malaria has incredible impact. The AIDS drugs were not getting to the poorest, they were only available to the richest and so work was done to bring those drug prices down to $100 a year and then to make sure that money was available. Global Fund has also been responsible for putting up bed nets and that's why malaria deaths are down by over a third. So it's an organisation that measures its work and works in a powerful way, and it's something our foundation gives a substantial amount to because we believe in the power of their work.

I mentioned vaccines. Vaccines are kind of a miracle and there's a group that was organised just over ten years ago called the Global Alliance for Vaccines to get vaccines out, to make sure they were affordable and it saved over five million lives by doing that. The Australian Government in recent years has become a significant giver to this group and in some ways it's the easiest thing to measure of all. In fact, when there's been aid reviews either here or in the UK or other countries, this often comes out as the very top rank, because the ability to get the impact out there, measure the impact, avoid corruption at any meaningful level is very, very strong.

GAVI gets very good prices, we've worked with GAVI to make volume commitments, and so by far the lowest prices in the world are gotten for the poorest children. In fact, prices that are at the marginal cost and with volume guarantees those marginal costs can be very, very low. The effect of vaccines - I mentioned smallpox, many other diseases that have been dropped down in big numbers. You know, the smallpox thing alone would justify all of this. Once they had the vaccine - that goes back to 1970 with an Australian scientist, Frank Fenner - they knew that this was possible to achieve. This is the only time that's been done. There's only one human disease that's ever been eradicated.

A few times the world decided to try and get rid of malaria, but that was not successful, because they didn't have good enough tools. The belief is that with three to four more years of progress on polio, that we'll have the credibility and the advance in tools that I think the world will undertake a plan to eradicate malaria, building on that success, but we need a few more tools and a little more progress with the one thing that the world is focussed on, which is polio, before we get there.

A number of diseases can't be eradicated, but the numbers can be brought down a lot. Respiratory disease sometimes called pneumonia, there's a new vaccine rolling out for that that makes a huge difference. I mentioned rotavirus and how we're finally getting that out and a new one that GAVI's just beginning to get out is kind of a surprising vaccine. This is a vaccine called HPV that actually prevents women from getting cervical cancer. It was kind of an amazing discovery when that was figured out and this is due to an Australian scientist, Ian Frazer, who helped pull this together. Actually, people were very doubtful about his theory that this could make a difference, but in fact he, working with others, was able to prove that this works and so cervical cancer, which kills 270,000 people every year, will be a thing of the past once we can get this vaccine out.

We're at the very start of that and the ability of GAVI to get it out will be totally dependent on its financial resources. Rich countries are rolling out very quickly including here in Australia, but the question is will it be a 10-year lag or 20-year lag before the poorest children who are at greater risk have it available? Historically, it's often taken 30 years or more to get these life saving tools out, but now that shouldn't be necessary. We should get it out, you know, say within a decade of today to all the girls in need.

Now let me talk a bit about polio. Polio's the thing I've been spending the majority of my time on over the last few years. It's one that there was a campaign that was announced back in 1988 and, in fact, there's been an amazing organisation that's been behind this. It was about 35 years ago that Australian Rotarian Sir Clemence Renouf read about the smallpox eradication and he decided that maybe Rotary ought to get involved in a polio eradication. In fact, here we show three Australians, all of whom were at one time or another presidents of Rotary International, and each of these have been incredible leaders to have Rotary stay behind this amazing commitment to see the polio eradication through.

It was due to Rotary that the campaign was started, and you can go to country after country and say that the engagement and generosity and volunteer work to carry this campaign forward really has been due to what Rotary did, and so they founded an initiative called the Global Polio Eradication Initiative. At the start, here's what it looked like. All the countries that are in yellow there had polio, so most of the countries of the world other than North America and over other 360,000 children a year were either being killed or paralysed. For rich countries it was back in the 1950s and early '60s that we last had this disease, and so a little bit, you know, we can ask, we can remember, you know, did parents want to send their kids to the pool and how tragic the disease was, but the success in eradicating there told the world that maybe it could be done everywhere.

Now, for 12 years this campaign got very well and got the numbers down to actually a pretty small amount, but then from 2000 to 2010 those numbers stagnated. We had to rededicate ourselves, so for the last three years we've had to raise additional money, come up with innovative tactics and we've started to see really phenomenal progress. In fact, India reported its last case in early 2011 and so now we're down to three countries that have polio left and less than 300 cases a year. The three countries you can see are Nigeria there in Africa, and Pakistan and Afghanistan up in Asia, and that's really one epidemic. So you just have the two places that we've got this challenge.

Now, the budget to get this done is pretty significant. It's 5.5 billion over 6 years, but the beauty of this is that once it's done, the world will save two billion a year and that will be now spent on other health causes, on measles, malaria and many other things. Also, the money that's being spent, about half of that will strengthen the health systems, so that for other diseases we are able to get more vaccines out, and so it's not just about the polio, it's about the health systems in general. So this is a detailed plan to get done by 2018.

We had a strong shot in the arm for this campaign back in 2011 when the Commonwealth heads of government met in Perth and Prime Minister Gillard and then-Foreign Minister Rudd stepped up, pledging an historic $50 million to help drive this campaign forward. Today I've had discussions about polio with a number of people in the government, about taking that commitment which extended through 2014 and adding an extra four years of commitment to that, and I'm hopeful in the near future we'll see a positive announcement about that, which would be very exciting. Finishing polio really is worth it because it will improve these health systems and save so much money, two billion every year, and so it would be a really great legacy to get this done and it will embolden us to take on other foes like malaria.

Let me finish by talking about agriculture. The foundation's early work was mostly on health, but then we realised that when you didn't have good agriculture productivity, that put kids' health at risk. They need both bulk nutrition and micronutrients so that their brain develops properly and not only does that protect them from disease, it also is critical to when they do get a school experience, are they able to learn? And so you really have to couple agricultural and nutrition policies together with health and educational policies for countries to become self-sufficient.

There's still a billion people out of a bit over six billion who are chronically hungry and if we look at the trends we'll see that, in fact, in South Asia the productivity in agriculture has gone up and the poverty rate has gone down. This is due to a agriculture productivity increase called the green revolution where staple crops like wheat, rice and maize have significantly increased productivity. On the right, though, you see the equivalent numbers for Africa and you see poverty rate unfortunately stayed the same, did not go down and the agriculture productivity rate stayed low, didn't go up whatsoever, even starting at a lower level than Asia did, and so there's a huge disparity here in these agriculture levels.

You know, rich countries have gone up hugely in their agriculture productivity. China's gone up hugely. Australia would show as one of the big gainers on this, but in fact Africa has not, and so what we need to do is we need to raise productivity still in a number of Asian countries, not China so much, but a number of agrisystems still need this and in Africa, and it is possible with new seeds to double or triple these productivities. This is done, we can take over 400 million out of poverty, and there's another great project along these lines that's been done here in Australia.

Same time that Melinda and I were up in the North seeing the dengue work, we also visited Dr James Dale, who's a biotechnology researcher at the University of Queensland who's planting new types of bananas up in the North and it's really groundbreaking work. The banana is an important crop in Africa. In fact, in a country like Uganda it's the main part of the diet and the kids in Uganda have huge deficiencies in iron and vitamin A and so the goal that Dr Dale took on was to breed these bananas, in this case using a genetic technique to breed them in a way so they express a lot more iron and vitamin A and once you get this, you reduce this stunting and malnutrition and this lack of brain development.

So if you can get it into the crop itself it's very magical, and he's making really good progress. He's got a great relationship with the people in Africa and it looks like in the years ahead it's something that will get rolled out and it's sustainable in the most - the strongest sense, because it doesn't cost anymore to grow these new bananas than it did to grow the old ones. So once that seed is in place, you really are done.

Well, going back to the aid picture and the generosity that drives all this, you know, Australian aid has been generous. It's up at that 0.37 level. The increase is being put against many things. In fact, in health and agriculture the partnerships between the Australian groups and our foundation are very, very strong. There's opportunities, of course, to do more whether it's more Australian research in health or in agriculture, more to delivery both in the region and to the poorest countries worldwide. There'll be opportunities like Global Fund and GAVI coming up, you're hosting the International Aid Society, you've got the G20 Conference [audio skip] here, and so a real opportunity to step up and show the strong leadership that people hope for and expect of Australia.

So thank you for all you've done. This is very exciting work. I've committed my life and resources to it and it's very gratifying, so I hope all of you will visit some of these things and get even more drawn in and committed to the cause. Thank you.

Last Updated: 28 May 2013
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