Bill Gates: The Impatient Optimist The Richard Dimbleby Lecture

Welcome to the 2013 Richard Dimbleby lecture. The lecture was

founded over 40 years ago in memory of my father, who was one of the

BBC's great founding broadcasters. Its purpose is to give a unique

platform to individuals of distinction who've made their mark

as leaders in the arts, business, science and politics and there by,

in the broadest sense, have made a significant contribution to the

culture of our times. Very few, if any of our previous speakers, could

claim to have made a bigger mark than this evening's lecturer. Bill

Gates is of course, one of the world's most famous and successful

entrepreneurs, the founder and chairman of a huge global

corporation. He started out, by his own account, as the ultimate

computer geek. As a college student, he also had the imagination to see

that one way or another, the digital age would transform the

lives of everyone on the planet and not only that, he real aislesed

that the new technologies could be -- he realised that the new

technologies could be available to all of us. In 1975, at the age of

20, he dropped out of Harvard to per sue this vision. With his

childhood friend Paul Allen he set up what is now that software giant,

Microsoft. By the age of 31, he was a billionaire and very soon after

that, one of the very richest men on the planet. Ever since, he's

been at or around the top of those lists which name the men or women

who seem to be shaping the course of our history. Today, however,

that is not least because he is also one of the world's great

philanthropists, a 21st century descendant of a long American

tradition which has yet to be emulated to anything like the same

degree in any other nation. It started on a large scale almost 20

years ago and is now renowned as the Bill and Melinda Gates Gates

Foundation. Supported by others, including Warren Buffett. It is now

the biggest charitable organisation in the world. It operates in more

than 100 countries. Its guiding principle is simple - every life

has equal value. Bill and ple Linda are at the forefront of a global --

Melinda are at the forefront of a global programme to help people,

wherever they may be, to lead healthy and productive lifes. Their

commitment and immersion in this project is self-evident.

Individually and together, though they never boast of it, the

foundation takes up virtually all their time and energy. Tonight,

Bill Gates is here to tell us how he arrived at this point, why it

matters to him and what he believes he can and will achieve. The

lecture is entitled "The Impatient Optimist". Would you please welcome

Bill Gates. Thank you Jonathan. It's a pleasure

to be at the Royal Institution to honour Richard Dimbleby. As I got

ready for this evening, and learned more about him, I developed a

strong sense of admiration. To prepare for a recent trip to

Ethiopia, I read up on that country's history. I kept seeing

Jonathan Dimbleby's name. In 1973, he stumbled upon, those were his

words, the brutal famine that emperor Haile Selassie had been

concealing from the outside world. The documentary he produced, The

Unknown Famine, did what great journalism is supposed to do -

shine a light on the dark corners where human misery is hiding. The

images of starvation from The Unknown Famine set the world on

fire. Television viewers in the United Kingdom and other countries

started sending donations, a total of 150 million to help alleviate

the suffering. When another famine tore through the Horn of Africa a

decade later, Michael Buerk and Bob Geldof helped to get a bigger

public response. These two operations set the standard for how

we react to global catstrophes. When people saw the famine,

actually saw what it was doing to children, they found a way to take

action. I'm optimistic about people. I believe a vast generosity is part

of our nature. The key question is whether the people who need our

generosity become visible or remain invisible. For my wife Melinda and

I, the problem of global health and equity became visible 15 years ago,

when we saw a simple pie chart in a newspaper breaking down the major

causes of death among children. One of the bigger slices of the pie,

representing 500,000 dead children annually was labelled rotavirus.

I'd never heard of it. Melinda had never heard of it. It turns out

it's the leading cause of diarrhoea, preventible with a vaccine that

only children in rich countries were getting. Our reaction was

somewhere between disbelief and disgust. How could we not have seen

even the bearest outlines of this tragedy. That rotavirus slice in

the pie set us on fire. I was in my early 40s and Melinda was in her

mid-30s. I was running Microsoft and we were starting a family. We

had plans to do a philanthropy later, when there was more time.

But all of a sudden, it didn't seem like there was time to waste. We

decided to do everything we could to get this vaccine out to every

child who needed it. Now, 12 of the world's poorest countries are

already giving the rotavirus vaccine to their children. That

number of countries is scheduled to climb to 40 by 2015. The rotavirus

mortality numbers are starting to come down. However, hundreds of

thousands of children are still dying from a disease that is both

preventible and treatable. The tension between how much the world

has achieved and how much is left to achieve is the reason Melinda

and I call ourselves impatient optimists. Tonight, I'll talk about

the project I'm spending most of my time on right now. It is the

subject about which I am most impatient and most optimistic. The

fight to eradicate polio. Most people in developed countries know

polio as a disease that used to paralyse lots of children. But it

isn't merely a historical curiosity. It still strikes children today. We

are working to wipe the virus off the face of the earth. We have

almost succeeded. There are only three countries in the world where

the virus is still being transmitted. Viewer than 250

children were paralysed last year. Stopping these last cases of polio

in these last countries is among the most difficult tasks the world

has ever assigned itself. But it's also among the most important. The

best of who we are, our capacity for innovation, our resill yepbs,

our sympathy for each other has gotten us to this threshold. Only

disease, poverty and indifference still stand in the way. The fight

to eradicate polio is a proving ground, a test, its outcome will

reveal what human beings are capable of and suggest how

ambitious we are about our future. When Melinda and I created the

foundation, we didn't know a lot about global health. We were

looking for an education. As luck would have it, one of the giants of

the field, one of the men most responsible for eradicating

smallpox happened to live in Seattle. He offered his help. His

name is Bill Foege. His father was a Lutheran minister. When Bill was

choosing a career he couldn't decide between public health and

preaching. He chose health, but his ministerial instincts still come

out when he speaks about his work. He's one of the most articulate and

inspiring leaders in a field where matters of life and death tend to

be mumified by jargon and statistics. I still look at his

speeches to remind me who global health is for. Here's a passage

from Bill's recents book on smallpox, House on Fire. In early

October 1977, a couple with two small children both with smallpox

approached the hospital in Merka, Somalia. They asked an employee for

directions to the infectious disease ward. A considerate person,

he took them into the ward rather than directing them. Although he'd

been vaccinate today was evidently not an effective take. Two weeks

later, on October 26, 1977, he developed the last smallpox rash

that Africa would ever see. In 1978, smallpox was declared to be the

first disease to be fully eradicated.

Bill Foege has the unique ability to see the forest and the trees to

celebrate the common decency of a man who refused to shun the sick

and appreciate the historic majesty of completely eradicating a disease.

He continues, "In medicine, the medical practitioner is obliged to

apply the best knowledge of the times to each patient. In public

health the obligation is to apply the best knowledge to the entire

human community. The purpose of public health is to promote social

justice. By 1978, publy health achieved its first complete success

in social justice for current humanity and for all future

generations. Bill helped me understand that it

is possible to eradicate polio bay plying the best knowledge of our

times and achieve the next complete success in social justice. In the

early years of our learning from Bill and many others, we developed

three convictions that are at the core of our work today: The first

condition is that when health improves life improves by every

measure. Many sceptics say - what's the point of saving a child from a

rotavirus death if the child won't get enough to eat or learn to read

or earn an income? While it's true that we also need to invest in

important areas like agriculture and education, in addition to

health, it's naive to think that these issues are separate. Disease

insin waits itself into every aspect of life. For a very high

percentage of African children it stunts their brain development. It

inhibits the absorption of nueftrigs. It weakens their drve

nutrition. It weekens their immune system for their life. Our goal

isn't merely to eliminate the deaths, it's to help lift the heavy

burden that sickness places on poor people's existence, so they can

seize the opportunities in the worlds of school, work and family.

In fact, when parents are more confident that their children will

survive, they tend to decide to have fewer children, gradually

bringing down population growth and leading to all sorts of beneficial

effects. The second conviction, progress is already happening at an

enormous scale. This is my all-time enormous scale. This is my all-time

favourite chart. In the year that I was born, more than 20 million

children under the age of five died. Last year, that number was 6.9

million. Keep in mind, that the million. Keep in mind, that the

world population keeps growing. The improvement is even more impressive

than it sounds. If the rate of death had remained constant since

1960, 31 million children would have died last year. The tens of

millions of lives already saved inspire us to do more because they

prove what's possible. The third conviction is that vaccines are a

miracle tool. They prevent disease from striking, which is better than

treating it after the fact. They are also relatively cheap and easy

to deliver. However, millions and millions of children don't get them.

This is still stunning to me. Before we started the foundation,

we assumed all the obvious steps were already being taken. Wield'

have to go after the more difficult, more expensive or least proven

solutions. In fact, our first big health investment was devoted to

improving the delivery of basic vaccines. I'm not saying it's a

simple matter to reach children with vaccines. It's actually quite

difficult, but universal coverage with today's vaccines is achievable.

It's also possible if we invest to invent new vaccines for diseases

like malaria. Both achievements will save millions of children's

lives. They're a major focus for our foundation. Delivering one

vaccine in particular, the polio vaccine, is the top goal of our

foundation. I'd like to turn now to that vaccine and to the disease it

prevents and explain why they are such a priority. Polio's been with

mankind for a long, long time. Archaeologists have found ancient

Egyptian carvings depicting people with withered limbs and walking

with canes. Around the turn of the twentsth century, increased

urbanisation -- Twentieth Century, increased urbanisation caused

epidemics of polio, which caused paralysis and extreme terror. When

the virus appeared, typically in the summer, it surged through

cities and towns filling up hospital wards with paralysed

children in a matter of days. An Irish journalist was infected in

the 1956 epidemic in Cork and has written about the panic that

surrounded him. "It was only on 13 June that the first case of polio

was reported in Cork city. By early July, the number had risen to six.

For the first time, reports of an epidemic begin to appear in the

local press. They were usually accompanied by subheadlines

claiming there was no occasion for undew alarm or outbreak a mild one.

These repeated understatements somehow conveyed the very sense of

fear which the newspapers were trying so hard to avoid. By the

middle of July, the number of children entering the fever

hospital in Cork had risen to four a day. People swimming in the river

Lee which flowed through Cork were threatened with prosecution. A

month into the epidemic, many were convinced that not only were the

dire facts of the epidemic suppressed in the city but that it

had spread to Dublin, where people were dying like flies in the fever

hospitals. Fortunately, that 1956 epidemic was among the last in

Western Europe. Jonas Saulk's polio vaccine had been approved the

previous year. When the second oral vaccine became available in 1960,

mass vaccination drove infections in developed countries down to

nearly zero. The fear and eventually, even the memro of polio,

faded away. -- memory. Polio wasn't gone, it just wasn't so

frighteningly visible in rich countries any more. It became a

disease of poverty, but in 1988, the World Health Assembly passed a

resolution supporting the global eradication of polio. In that year

the virus was circulating in 125 countries. It paralysed 350,000

children. Within eight years of the resolution, most countries had

resolution, most countries had built strong polio programmes.

Cases were down almost 90% globally. Melinda and I made our first

contribution to the campaign in 1999 and based on the trend lines,

we thought we were helping fund the we thought we were helping fund the

final stages of eradication. In 2000, the virus was circulating in

20 countries. By 2003, that number was just six. In 2005, Egypt and

Niger were declared polio free, leaving only four endemic countries.

But this virus is stubborn. In 2006, people in 13 countries that had

already achieved polio-free status were infected by travellers from

one of the four endemic countries. In several countries, as far flung

as Indonesia and Yemen, these importations led to large polio

outbreaks. It would be five years before India celebrated its last

case. There are still three endemic countries left - Afghanistan,

Pakistan and Nigeria. I can say without reservation that the last

mile is not only the hardest mile, it's also much harder than expected.

Let me try and explain how hard it is to eradicate polio by comparing

it to smallpox. Every single person infected with the smallpox virus

gets an unmistakable rash on their skin. The eradication straty,

pioneered by Bill Foege was called ring-fencing. As soon as you saw a

case, you vaccinated aggressively in nearby towns to contain the

virus. Polio, on the other hand, is transmitted silently. Only 1% of

infected people show symptoms. The other 99% are contagious, but they

don't know it. When you do see symptoms, they're not unique to

polio. They start with a fever and a headache. A few days later,

ordinary muscle aches get increasingly severe and your

reflexes slow down. Then, paralysis sets in. And the point at which a

health worker sees a child with paralysis begins a two-week waiting

period during which stool samples are collected, sent off to the lab

and tested. So by the time a positive diagnosis is confirmed,

the virus may have travelled hundreds of miles in any direction.

So ring-fencing doesn't work. Everybody everywhere is at risk at

all times unless they're immune. Therefore, the way to stop polio is

to fax nait an extremely high percentage of the -- vaccinate an

extremely high percentage of the population, leaving no reservoir of

susceptible people for the virus to survive. This threshold, what's

called herd immunity, varies by location. But it's never lower than

80% and in some locations, it's as high as 95%ment Now -- 95%. Now

achieving 95% coverage is difficult. Even rich countries, like the

United Kingdom only vaccinate 95% of their children. So how can poor

countries possibly achieve this high level of coverage? Take the

example of India. The most recent country to eliminate polio. India

started with the same basic approach that the UK and other

developed countries use, which is that you have children come into

the clinic at a young age for routine visits. When they visit

they get their vaccines. But in India, far too many Indian children

never see the clinic. So, the only way to get the coverage rates up is

to add a supply-side approach to the clinic-base add proch. They go

out to the community and find the children. They go after every child

under the age of five and vaccinate them house by house. Think about

what this requires. India has more than a billion people. It's 15

times larger than the United Kingdom. It has some of the most

severe terrain and weather in the world. Behind me I'm showing a

photograph taken in Bihar in the north of India during a flood in

2007. What you see are health workers walking for miles in waters

up to their waist to find and vaccinate children living in a

remote area along the Kosi River. Periodically, they'd reach a

village, like this one. Notice the vaccine box that's being carried on

the person's head. Not only do vaccinators have to track down

every child, but they have to keep the vaccines cold the entire time.

And this process doesn't just happen once. It happens six to 12

times a year so that they can get out and vaccinate every child three

or more times to get very high levels of immunity. Every day

75,000 new children are born and this is why India's polio programme

is so large. It employed over two million people, almost entirely

paid for by the Indian government. So India's accomplishment in wiping

out polio in 2011 is among the most impressive global health successes

there's ever been. I've just described some of India's

challenges. The challenges in Afghanistan, Pakistan and Nigeria

are just as daunting, but somewhat different. A decade ago in Nigeria,

some leaders in the northern part of the country started a rumour

that the polio vaccine reduced fertility in the children who

received it. Campaigns had to be suspended for a year while

officials disproved these allegations. A large epidemic

sliced through northern Nigeria and polio spread back into about 20

nearby countries where it had been eliminated. All those countries had

to ramp up again for an intense fight to eliminate the virus.

Nigeria, the -- in Nigeria, the rumours persisted to. This day,

some parents refuse to let their children be vaccinated. In

Afghanistan and Pakistan, militants in some areas won't give

vaccinators access to local children. Even in some of the

places where vaccinators can go, there's no guarantee against the

threat of violence. When I lay out these facts, I often get two

questions: First, given the challenges is it possible to -- is

it possible? And second, should we bodger to put all the efforts into

this to get the eradication? So I'm going to spend the rest of my time

answering these two questions. I'll answer yes, we can eradicate polio

and yes, we should. At the time Melinda and I created

our foundation, we included provision in the bilaws saying that

within 20 years of the last of us to die the foundation should spend

all of its money against the causes of health inequity. We believe that

between now and then the great inequity can actually be eliminated.

That's why we do this work. Because we believe in the power of

innovation to solve that problem. Innovation is amazing, an amazing

thing. After all, knowledge is increasing. There's constant

invention of new things. Once they're invented they're not

uninvented. They keep moving forward. The Royal Institution

where we are today is an important part of this great history of ideas.

Here many leading scientists of the modern age have lectured about

their discoverries, building the foundation of our understanding

idea by idea. It was my belief in innovation that

led me, at a young age, to start Microsoft. When I was a teenager,

computers were the size of a car and far more expensive. I had to

sneak in to computer labs at a nearby college to get a bit of

computer time. Now the idea of computer time being incredibly

scarce doesn't even make sense. In the 1970s, it was considered wild

when we talked about the idea of everybody having a computer. We

said a computer on every desk top. Now we can almost take for granted

that there's a computer in almost every pocket. So this pace of

innovation is accelerating. The same is true of our understanding

of polio. It was first recognised 4,000 years ago. But it was only

200 years ago when we figured out that it was contagious. 100 years

ago we learned it was caused by a virus. And 50 years ago, we

developed the first vaccine to prevent it. 25 years ago, we

resolved to eradicate it. I asked the Science Museum if I could

borrow this machine to show you an example of what polio-related

innovation looks like. This is a Smith-Clarke Junoir Cabinet

Respirator, better known as an iron lung. This version was developed by

George Thomas Smith-Clarke in 1956. In addition to paralysing arms and

legs, the polio virus can affect the nerves that let you control the

muscles that inflate your lungs. In these cases, patients are unable to

breathe on their own. Behind me you can see a photo of what it looked

like when an iron lung was used to help children breathe. They were

sealed inside it. For centuries, artificial respiration was

something that medicine sought, drowning and gas inhalation were

common causes of death in the 19th century. Nothing could be done to

revive people who stopped breathing. One early device that seemed to

work required a person operating it to blow into a tube 30 times a

minute or 43,000 times a day. To test the first iron lung,

researchers injected a cat with a south American poison until it

stopped breathing. Then they put it into the prototype. The machine

breathed for the cat, with the air going in and out of the machine

inflating the cat's lungs. When the poison wore off, the cat survived.

The inventors raced each other to make improvements to this iron lung

concept. Now children who had inability to breathe with polio

many of them recover but they remember vividly their time in the

iron lung with horror. Upon derg possible death, their parents could

only see them in a mirror, touched above their immobilised heads. This

did save thousands of lives and it fulfilled the aspirations of the

medical community. But now, this contraption filled with oral

vaccine has saved millions of lives. It's the reason the iron lung is

now in a museum. This is innovation. When a solution is so powerful that

it changes the way we think about a problem, not how can paralysed

lungs inflate, but how can we keep them from being paralysed in the

first place. Innovation is helping us overcome the obstacles that

still stand in the way of eradication. In the past year,

Nigeria started using a new technology in an innovative way to

solve an important problem. How do you vaccinate every child when you

don't know how many there are? The polio programme has always used

microplans to create little maps for vaccinators. These maps cover

the entire country and point out where the vaccinators are supposed

to visit. They're called micro because they get down to the level

of the individual hut and they're supposed to show a lot of precision.

But the maps on which the microplans were based look like

this. These maps simply weren't accurate

enough or detailed enough to drive universal coverage. Thousands of

settlements were simply overlooked. The distances between different

locations could be off by a long, long amount, meaning that what a

microplan said was a 20-mile trip during the day might end up being

more than 40 miles and something that couldn't abcheefd in a day. --

achieved in a day. The result was a plan that didn't actually plan to

vaccinate every child and that didn't actual lay chief vaccination

of every child in the plan. -- actually achieve vaccination of

every child in the plan. Now we're using high resolution sat lie

imagery to get the latest maps that look like this.

This process has identified thousands of additional settlements

that had been missing from the micromans. These maps show the real

-- microplans. These maps show the real distances. So vaccinators are

assigned a full day's work, but no more. The question is no longer how

many children are there and where might we find them all? It is how

do we most efficiently visit every child on this map? Innovations like

this are a key reason for my optimism. Innovation alone won't

drive this. It's not inherently good or bad. It just has the

potential to be transformative. To make sure the innovation transforms

our world in positive ways we need to point it in the right direction.

That takes public will. Many organisations helped push the

eradication resolution through the World Health Assembly. But the one

you wouldn't expect is Rotary International. They're a service

organisation with 1.2 million members in almost every country of

the world, including more than 50,000 in Great Britain and

Irelandment Rotarians pledged to put service

above self. It's their motto. They have no specific global health

mandate. They're not polio experts. They're regular people, but they go

out and spend their time working with families as part of this cause.

For three decades they've spend time advocating for polio

eradication, raising money, supporting vaccination and actually

going out to get involved in the campaigns. Other key partners

include the Center for Disease Control, UNICEF, and the World

Health Organisation. All of them have special talents they bring to

the campaign. But that's not enough. We need the broad community, people

have nothing to do directly with the health of the poor. We need

broad public will. Take the example of Nigeria, where the public had

been reluctant to vaccinate children after rumours about the

vaccine. I went there for the first time four years ago to meet two

groups of leaders. The religious leaders in the north were in the

best position to encourage anxious parents to vaccinate their children

and the state governors who have the power to hold the health system

accountable for quality work. I met with the religious leaders in the

palace of the Sultan of sow co-toe. They heralded may rifle with

Blairing horns. The Sultan gave me a white horse as a give. I demurred

because I didn't have room on my plane. The Sultan and I got down to

business talking about polio. The next day I met with a large group

of state governors in the capital Abuja. At the end of this two-hour

meeting we all signed a document, committing ourself to the goal of

eve rad indication and spelling out -- of eradication and spelling out

personal obligations. I see a strong commitment from leaders in

all three endemic countries. In September I was in New York

attending a UN polio meeting that included Presidents Jonathan,

Karzai and Zardari, all there to talk about their commitment to

eradication. The fact of their presence showed that the initiative

has unprecedented momentum and commitment. We also need rich

country governments to be generous as well. The proof of Great

Leadership is the ability to be long siegtded and keep the big

picture in mind. The UK government's decision to prioritise

foreign aid, even in the face of financial challenges is exactly the

kind of commitment I'm speaking about. In fact, as I travel across

Europe, making the case for increases in aid budgets, I've

never been more proud than I am now of the knighthood I was awarded in

2005. So that leaves one final question -

why is it worth it? Polio doesn't kill as many people as AIDS,

tuberculosis, malaria or rotavirus. It's not even close. Why should the

world focus on eradicating it? First of all, there's no such thing

as keeping polio at its current low levels. We've gone to this point

because vaccinators are wading through flooded rivers, governments

in developing countries are investing scarce resources and the

global health community is on high alert. These are not sustainable

approaches. If we don't keep investing, cases will shoot back up,

at least to the tens of thousands, in dozens of countries.

Second, successful generates lesson that's will benefit all of tkphrobl

health. We're on the verge of doing something -- global health. We're

on the verge of doing something we haven't done before, reaching the

vast majority of all children in the toughest places in the world.

We're building systems, developing technology and training workers

that make it possible to help people who didn't get help before.

When polio is gone, we'll use the same systems, technology and people

to deliver other life-saving solutions, especially routine

vaccinations for diseases like rotavirus and measles. These are

practical arguments. I believe they're convincing, however the

argument that really moves me the most is more idealist iction. By

doing something really hard for each other we'll demonstrate what

is best about humanity. That will inspire us to be more ambitious

about what is possible in other endeavours. Last month, nine

vaccinators from Pakistan were murdered by masked militants. At

the beginning of a three-day polio campaign. The youngest, a 17-year-

old volunteer, received several death threats in the week leading

up to the campaign and was forced to move between houses for her

safety. She was standing a few feet from her sister when she was shot

and killed. To me, the nihilism behind these coordinated attacks,

seeking out the goodness to destroy it is the opposite of what the

eradication fight is all about. The vaccinators were trying to stop

disease and ease suffering so that people they would never meet could

have a better life. They're heroes. There's two ways to memorialise

them. The first is to do our best to ensure the safety of those who

continue the campaigns and the second is to finish the task that

they gave their lives for. I'm committed to doing whatever it

takes to win this fight. I don't take that lightly. I'm in the a

wishful thinker. The global polio community now has a detailed plan

from getting here to eradication. It's based on a careful analysis of

what countries have accomplished in the past and what still needs to be

accomplished in the endemic countries. The plan says that if

the world supplies the necessary funds, political commitment and

resolve we will certify the eradication of polio by 2018.

Funds, commitment and resolve, those are the key variables. If the

world delivers, then we'll eradicate polio within six years.

It will be an entry on a long list of improvements to the human

condition. We cut the child mortality rate by 75% in the past

five decades. We cut the poverty rates by 50% in the past two

decades. We eradicated smallpox. These are mindboggling successes.