Full Interview: Bill Gates on global health, clean energy, Trump, Microsoft and the future of the world

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Nearly a decade after leaving his full-time job at Microsoft, Bill Gates sat down with GeekWire for an extensive interview about his work at the Gates Foundation, progress in global health and clean energy, and his outlook on the world. The billionaire investor was optimistic about the future, and said he believes the U.S. can continue to lead the way in science, innovation, energy and more.

Watch the full video interview above, listen to the podcast below, download the conversation as an MP3, or continue reading for the full transcript.

[More coverage: Find out what Gates wants from President Trump, what he and Melinda Gates are doing with Warren Buffett’s $30 billion, and what Bill Gates is focusing on in his spare time back at Microsoft. See these video highlights for more, and read our in-depth look at an innovative new program, championed by Gates, that aims to solve the mystery of early childhood deaths.]

Todd Bishop: You and Melinda Gates refer to yourselves sometimes as “impatient optimists.” For a lot of people in the world right now, looking at things like the economy, poverty, jobs, war, disease, terrorism, the future of the planet, it’s hard to be optimistic. What makes you optimistic about the state of the world, and how do you maintain that optimism while still being grounded in reality?

Bill Gates: Objectively, there’s a lot of great things that have happened over almost any time period you want to choose, whether it’s issues like rights or health or education. The world is improving.

Our work in global health is about things like cutting childhood deaths, and every year we continue to make progress there. The scientific understanding of some of these diseases is advancing quite rapidly. There’s some things like premature birth or nutrition, first day deaths that we need a lot more insights so that we can build the tools to solve those problems.

Even in some of our vaccine areas, like an AIDS vaccine, things have taken longer than we expected, but we have the pipeline of tools. The biological information that we have that gives us insights is fantastic. Even for the diseases we don’t focus on, cancer, heart disease, you’re going to be way better off being sick 10 years from now than any time in the past.

Bishop: This year’s annual letter from you and Melinda is a great read because it’s literally a letter to Warren Buffett, 10 years after his historic donation to the Gates Foundation. As you say in the letter, “it was the biggest single gift anyone ever gave anybody for anything.” So tell us, what have you been doing with Mr. Buffett’s $30 billion over the last 10 years?

Gates: It was really phenomenal. It grew out of the friendship that we had and the fact that his plan to have his wife run the foundation and give things away changed when she tragically died. Ironically, it was at the same time period where I was announcing to the public, in 2006, that I’d be leaving Microsoft in a couple of years and focusing full-time on the foundation. That was the time at which we went back to New York and Warren announced these gifts to a number of foundations, with a very high percentage of it going to us and basically doubling our capacity.

That’s an incredible thing because when you get that doubling you can say, “okay, what’s been working?” Or take agriculture, where we haven’t done much, or sanitation; saying, “okay, we will be able to make a really huge effort there.” It really energized the foundation and half of what we’ve gotten done in this last decade is because Warren trusted us.

Here we’re writing back to him an honest appraisal of, what metrics do we look at? It’s not profitability. Most of the people who work for Warren can say, “how are you feeling about your business?” and if they try and say, “okay, it’s something other than profitability,” he’ll say, “wait a minute, what game are we playing here?”

In the philanthropy game, you’re going for different outcomes: saving childhood lives, having kids grow up — because they don’t have malnutrition or disease — that they achieve their full potential. We take for Warren things that, because he’s very intelligent about the world but doesn’t get to go out in Africa and see what we see, we’ve taken and say to him where we stand and it’s basically a very positive report that his gift has made a phenomenal difference.

Warren Buffett, left, Melinda Gates and Bill Gates stand together June 25, 2006, in New York, shortly after Warren Buffett’s announcement of his historic donations. (Gates Foundation Photo)

Todd Bishop: One of the key pieces of data, in fact, perhaps the most important piece of data, is childhood mortality — deaths under 5 years old. You also talk about newborn mortality as being the leading indicator of that. It seems that, if the world were an operating system, childhood mortality would be the highest priority bug. How do you look at tackling this problem and how do you explain to people why childhood mortality is so important to fix?

Bill Gates: The death of a child is an incredible tragedy all over the world. Back in 1990, about 12 percent of children were dying before they reached the age of 5. Now we’ve got that down to about 5 percent, so we’ve more than cut it in half, and that’s because we’re getting vaccines out, economic improvement also helps there, but the vaccines are why we’ve seen an acceleration in getting that down.

We’re creating this alliance, GAVI, that has helped buy the vaccines that were in the rich world but not getting to the poor kids, getting a very cheap price and figuring out the cold chain, getting the delivery right, and then funding research for new vaccines. A lot of them are coming along. We’ve got a meningitis vaccine out, got that through large parts of Africa. That has been a huge success. Thinking about impact on children meant adding to the agenda, both the R&D agenda and the delivery agenda, but it’s amazing news, even in the scale of other tragedies.

People think about this idea that there’s 122 million kids that are alive that would not be if that fatality rate had stayed at the 1990 level, that’s 122 million families. If we were just talking about 1 or 2 lives and, do we want to go out and help that mother and help save her child, we’d be very moved and we’d put resource into that. Here it’s actually big enough that it’s a worldwide thing that families are better off.

Todd Bishop: You describe vaccines, in particular, as the greatest deal in philanthropy, this is speaking in Warren Buffett’s terms. You say it’s like an investment in Berkshire Hathaway 30 years ago, the investment in vaccines. What needs to happen next in vaccines to solve all of these issues that you’re still running into with TB and everything like that?

Bill Gates: We’re still missing about a dozen vaccines that will make a huge difference. For adults, we’ve got HIV and TB are still huge; for kids malaria is still killing a half million kids a year out of that 6 million. For that first 30 days, or even that first day, we need to see what’s causing the infection. So there, we probably need some vaccines, but we need a little more data to make sure we’re getting the vaccines that will save the most lives.

We’re very enthused about the idea that in the third trimester we actually give the mother a vaccine and her antibodies, the protective things that the immune system makes, actually pass through to the baby, both when the baby is born, and through the mother’s milk. Because the baby’s immune system is actually not very strong for that first few months, using the mother’s immune system to do this — it’s a very exciting idea and something that we’re investing heavily in.

Todd Bishop: You’ve said you talked to President Trump about innovation generally. Did you talk with him about vaccines when you met with him?

Bill Gates: Absolutely. I talked about during the next 4 years we hope to get an HIV vaccine, that’s been harder than people expected. I talked about polio, where getting the vaccine for polio out to so many children, we found ourselves with less than 50 cases last year, so this year with luck we’ll see the last cases. Then 3 years later is when they certify that you really have done the surveillance and the disease really is gone. So investing in innovation, which was my broad theme talking to him, that included health vaccines, it included energy and education.

The idea that some of these investments that government makes create the platform, then the private sector can take it from there. The analogy is to things like the moon shot, and well I said, “Okay, get behind an innovation agenda.” I don’t know if that will happen but I wanted to get that in front of him.

Bill Gates discusses the 2017 Gates Foundation Annual Letter (GeekWire Photo / Kevin Lisota)

Todd Bishop: Did he seem receptive?

Bill Gates: He’s met with all sorts of different groups about a lot of different things, but yes, he took the time, he listened and he wanted to understand about some of the different diseases and the strength of the American role in doing all these things. I went through the economics of how vaccines — even though the cost of making the first one, the R&D is very high — that the marginal cost of making these things brings them down to under a dollar eventually, you get the volume up.

Todd Bishop: Yet there was a report that he was considering [vaccine skeptic] Robert F. Kennedy Jr. for a vaccine review committee, and Trump himself has been skeptical about vaccines and the connection to autism, which is something that you’ve disputed. How do you get that across to him, and what are the repercussions of Trump’s presidency if you look at the impact on vaccines in the US and the implications for global health?

Bill Gates: Well vaccines are a miracle; they’re fantastic. Anything that makes people hesitate to give their children these vaccines according to the recommended schedule creates risk. Risk for the children who don’t get vaccinated and risk for children, some of whom don’t have an immune system, so they’re benefiting from the fact that the community protection means the disease doesn’t get to them.

Getting the word out that, yes vaccines are great, the safety data’s very, very clear, including any of these specific concerns, that’s very important to our foundation. Every country, the rumor mill often works against us there, so we’ll have to see how that one develops. I would certainly use my voice to try and avoid anything that undermines confidence, so that parents are using vaccines fully.

Todd Bishop: Did you talk to him about the environment, global warming and energy as well?

Bill Gates: Yes. My innovation message, specifically including energy, happened to be the same week that on Monday and Tuesday I announced the Breakthrough Energy Venture Group. Then on that Tuesday afternoon, in December, was when I sat down with him. I explained the US has great science here, this is where the market for these things is going to be. It connects to less pollution, it connects to U.S. jobs, it connects to security, not needing the energy coming from far away. Energy is very primal stuff and there are a lot of leads that are promising, still at a fairly risky stage, but over the next decade some of these breakthrough approaches are going to pay out, and U.S. research and U.S. leadership on this should be part of how it gets solved.

Bill Gates discusses the 2017 Gates Foundation Annual Letter (GeekWire Photo / Kevin Lisota)

Todd Bishop: Yet Donald Trump has called global warming a hoax, and his choice to head the E.P.A, Scott Pruitt, is a climate change skeptic, at best. What’s going to happen to the planet under the Trump administration?

Bill Gates: We’re in a period of uncertainty about administration policies and the range of what might happen is particularly higher. I don’t think that these R&D and innovation budgets will be substantially reduced. I think there’s even a chance that they might be increased and we should go and make that case to the executive branch, to the Congress. R&D generally has been a bipartisan thing, because in the IT space, in the medical space, the U.S., the benefits to ourselves and the world and our economy have been very, very clear. I’m hopeful we can make a very strong case there. Energy is actually harder; it takes more time to get a product, but if you do it’s a very, very big market and the constraints of doing that in a clean way are more obvious all the time. Not only do we need to do it, we need to do it with some sense of urgency.

Todd Bishop: Are you optimistic about a Trump presidency at this point?

Bill Gates: I know that historically our foundation has had great relations with all the administrations. Clinton administration did a lot of outreach. The greatest rise in U.S. foreign aid was under the Bush administration, that’s where we got the AIDS initiative, which is called PEPFAR. We got a malaria initiative, really a phenomenal time, even though in the early stages there was some uncertainty. Then of course Obama, although he had budget constraints, he believed in these things; a lot of new initiatives, including in agriculture.

Hopefully, whether it’s energy or child vaccines, the case of the many benefits helping countries so that they are stable, so these refugee problems that have been troubling for Europe — a little less so for the U.S. but, even so, a lot of controversy there — these things are why the future’s going to be better than the past. People really do look to the United States, so we’ll be there making the case. In most of these things our foundation is a co-funder, so I can say that a polio or an HIV vaccine, that I’m putting our resources behind it in a very big way and the U.S. government would be the best partner for those efforts.

Todd Bishop: You have not shied away from controversial positions, and one of them comes out in the letter. You upset some health officials by suggesting doing autopsies on kids who were dying mysteriously, to figure out why. This work is now being pursued by a group called CHAMPS, the Child Health and Mortality Prevention Surveillance Network. Why is it so important, why did you push for the childhood autopsies?

Bill Gates: I think that’s a case where by knowing very little, a question that those in the field have not chosen to go after, the outsider can say, “well wait a minute. Yeah that might be hard, but boy let’s really try because it would be so valuable.” As we have taken diarrhea and pneumonia down, even malaria down quite a bit, the portion of the days that are very early in that 5 years — the first month, the first day — it’s about half now. Yet that’s the part we understand the least.

When a 3 or 4 year old dies, almost all the time we understand what the approximate cause was. Some of these early deaths we don’t know much at all. Was there an infection there? Is there some new tool — antibiotic, vaccine — that could have saved that child’s life? Now the immediate response was, “okay, autopsies are very, very expensive, they’re somewhat disfiguring of the body, it’s just not realistic that either the skill or the permission would be there.” An incredible doctor came along, who said to us with just a few samples — the way you do the puncture, you wouldn’t even notice it because it’s a very small needle point — we can get a little bit from the lungs and a little bit from the gut and do what they now call minimally invasive autopsy, MIA. That can be done in these African countries, not for every child, but enough to get the statistics of what really is responsible.

I got to go and see one of the early ones where, tragically, the child had died, but the parents said, “yes, we’re glad to have you take these samples because it has a chance of helping parents in the future not have their child die.” The volunteer rate on this has been very good. We have the latest molecular diagnostic tools that are way more sensitive than ever. If one isn’t obvious it actually gets to Atlanta where the CDC Pathology Lab, which is the best in the world, is looking at this stuff. So now we’re gaining immense insights and say, “okay, what’s going on in those first 30 days?”

Todd Bishop: Another area where you and Melinda have taken a stand that has been controversial is contraception in the poorest countries. Why is this important? Melinda keeps a note of encouragement from Warren Buffett, saying it’s the gutsy thing but the right thing to do. What have you learned about taking a stand on this issue and has it influenced your willingness to take a stand on other issues?

Bill Gates: Contraception really shouldn’t be all that controversial because it’s a tool a woman can use to delay her first birth until she’s, say, 18 or 19 years old. She can use it to space births and she can use it to, with her husband, have the family size that they think is appropriate, so that in terms of nutrition and education they are able to do a good job for these young children. Making the contraception easy to get to, making it low cost — there’s lots of inconvenience so you’d need choice.

One of them is an injection that for 3 months you’re not fertile, so every 3 months you need to go and get that. We have a goal to make that self-injecting so you can give it to yourself instead of having to go off to a health worker. You could even buy a few of them in one trip and keep those, so cover yourself for 6 or 9 months. We’re learning about how we need to educate women, how does the supply chain work, getting those costs down. Very similar to what we’re doing in vaccines because it is a fundamental tool.

Todd Bishop: Let’s talk a little bit about the talent pipeline. People talk about this in technology. I’m really curious about how this works in global health and your perspective on it. What do you say to somebody who is graduating with a computer science and engineering degree in 2017? What should they be working on to make the biggest impact in the world, other than the latest version of the Snapchat spectacles or something like that?

Bill Gates: There’s progress available in many, many dimensions. If somebody’s working on AI, that is profound. It could really make a big difference, things like reading are the cutting edge there. Microsoft, Google, many others are moving full speed on that, so it’s a very exciting time. If somebody is working on a new medicine, computer science helps us model those things. We have a whole group here in Seattle called the Institute for Disease Modelling that is a mix of computer science and math-type people, and the progress we’re making in polio or plans for malaria or really driven by their deep insights.

If somebody is considering being willing to go out and work in the field in global health, those are a particular class of heroes because it’s hard to work in those places. Our foundation gets so many of our learnings from people who’ve been out there and seen, “this tool is not going to work there, there’s more of a problem here than you know.” You should really get involved in that. We don’t need a super high percentage of people to do it but the more we’re out there, the better. That deserves a special kind of praise.

Todd Bishop: Can technology and engineering alone save the world, is that enough?

Bill Gates: There’s no doubt that if you go back before 400 years ago, there were plenty of people who were caring and all that. The thing that came in was a mixture of science and engineering and incentives and market structures around that. The steam engine, the industrial revolution, eventually electricity, cheap cars. In the early parts of that Robert Gordon book that talks about how the 1870 the 1970 period — focused in the U.S. with a bit of a leg for other geographies — that was a miraculous period of time. Yes, science and engineering were necessary elements of that. When we say, “will people be dying of cancer?” Science will help us with that.

Still, in terms of helping older people or students with special needs, all of these things have to be delivered in a kind way. Teaching is the human thing, in terms of building the kids’ self-confidence, so if we take the broad ways that we want to see society to be better, science can only provide certain pieces of that. If we can avoid climate change it makes it easier if we can make energy cheap and food cheap, but all human skills will still be important reaching out to those in need.

Todd Bishop: It’s been just about nine years since you ended your day-to-day role at Microsoft, almost a decade ago. What do you think about what’s happened at Microsoft over the past few years? A lot of people look at it as a revival, specially if you look at the stock market. Do you see it that way?

Bill Gates: Microsoft has some assets like Office that have stayed strong and there’s so much room for innovation in those. That’s probably the most amazing asset that Microsoft has, that globally the way people get productivity with Outlook, Word, they maintain that position and there’s so much more that they are doing, and I get to push a little bit and share ideas in my part-time work.

Something like Windows is still an unbelievable asset but because the world is somewhat phone-centric, it’s an asset that has to be managed very carefully to make sure that it’s extended, and there are very interesting things that are being done with that. It’s fantastic that Microsoft in the cloud space is one of very few companies that’s got the critical mass, the particular emphasis on helping business customers get up to that cloud with all the unique requirements they have. It’s very exciting. I’m very lucky that Satya and the team there creates an atmosphere that going in and pushing them a little bit and sending memos; they make that fun for me and actually, some of those ideas they latch onto.

Todd Bishop: What areas are you focusing on most in your time at Microsoft, advising them?

Bill Gates: The role of natural language and all these interactions to create an expert capability to help you out. That is very cutting edge and that influences a lot of the Bing investments we made over time, making it not just string search but deep understanding. The ability to keep track of information, not just as text, but understanding your activities and how you prioritize things.

When you go to look at communications you shouldn’t have to just look at a timed order fashion, you should trust that it’s understanding of you and the context and priorities are there. But only by reading that text will we do that, so there’s a frontier here that’s very exciting that Rajesh Jha, Harry Shum, a lot of the key people under Satya are grabbing onto that, and some particular opportunities around that are where the resources are being shifted.

Microsoft — by some metrics we’re less of a share. We had a very high share if you go to say 1995. But we are one of very few companies doing phenomenal things, and the basic insight of the company about the importance of software just gets underscored. People recognize that again and again, year after year. We’re not the only software company but we are a great software company doing some unique work. Our leadership has that — “hey, we are the best in certain ways,” and so we get the best people. That any kind of positive dynamic is quite good, so I love what’s going on there, it’s fun.

Todd Bishop: Tell me about your partnership with Melinda. What works and what do you need to work most on day-to-day, because everybody has to work on something with their partner in life and in philanthropy. Tell me about that partnership.

Bill Gates: Melinda has been my partner in raising the kids and I went from before I met her, intentionally having an unbalanced life, to having a more balanced life with all sorts of fun things that she and I do together.

The building of the foundation we’ve done together. It didn’t exist when we got married and both of us — in her case as the kids grew, in my case as I changed my Microsoft role — we’ve both been able to put more time in now. For both of us it’s full-time. We’ve got Sue as the CEO so the three of us on a day-to-day basis. We’ve got Warren as a co-trustee, so the three of us in terms of the broad strategy thing, those are our two great co-partners.

Bill and Melinda Gates
Bill and Melinda Gates visiting women in Jamsaut village in Bihar, India. ( Gates Foundation)

Melinda and I really get to brainstorm about what goes on and that’s why annual letter has become a joint thing. This week she’ll go to Nigeria while I go to Davos and then we’ll get back together. I go to Nigeria more than she does but now this time she’s going to go. It’s an area where there’s a lot of important work going on. She and I each will specialize a little bit but our strategy reviews that we do, we’re both there going through that. Even though it feels like a lot of money we have to make trade-offs we wish we could do more things, so we have to judge, which of those are making the most progress and what we should be involved in. We’re going to stick largely to what we’re doing now.

Anyway, she’s a lot of fun to work with. There’s some of the people skills that she’s better at and cares about more. It’d be a mistake not to think of her as very numerical and interested in the science. I enjoy, if I get ahead of her, say, understanding the immune system, then we can spend a few hours, where I’m going through how amazing it is and interesting, and how that affects our creating new products, so I’ve always had a partner. This is, in a sense, more profound because we’re lifetime partners and we’re going to be doing this the rest of our lives, but it’s a lot of fun doing it with her.

Todd Bishop: Final thoughts: what message would you want to leave people with as you’re releasing your annual letter in 2017?

Bill Gates: One of the things we cite is how low the awareness is of the progress that’s going on. If you feel like foreign aid and science, and even the world at large isn’t improving a lot, then the idea of finding, okay, what are the things we’ve been doing let’s do more of those things. It’s a real concern that if people see the world not getting better, that the investments to accelerate the good parts of the change won’t really be there. Talking about why we’re excited and showing people, yes we are being realistic and we are looking at how U.S. generosity is being spent in a smarter way today than before.

That sense of progress, the sense of opportunity, I hope that comes across to people because we need to draw people into this work, whether as careers, or givers to these causes or just the political voice that these equity issues should stay on the agenda.

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