• People & Places

35 Who Made a Difference: Bill Gates

The king of software takes on his biggest challenge yet

• By Jimmy Carter
• Smithsonian magazine, November 2005

As a former engineer and businessman, I've long admired Bill Gates' innovative entrepreneurship: while we share a high regard for the vision it takes to achieve far-reaching goals, he far surpassed anything I accomplished in engineering and business. He sees how the world can be made better with the strategic and daring use of time, talent and resources.

Through the Bill & Melinda Gates Foundation, Bill has brought the same far-sighted approach to public health challenges in the developing world as he did to computer technology. Just as he changed the landscape of electronic communication, his foundation is reshaping the landscape of deadly and debilitating diseases in the developing world. Someday, this may be his greatest legacy.

I first met Bill and his wife, Melinda, in 2000 at their foundation's original, low-key offices in Seattle. As I usually do in an initial meeting with a new acquaintance, I described in detail the work of The Carter Center in the many poor and underdeveloped countries where we operate. It was quickly obvious that Bill knew as much as or more than I did about many of these countries and that he fully understood the devastating impact diseases had on their citizens. This was my first insight into how much he cared about the underprivileged around the world and how much knowledge he could absorb and retain. I knew then I would have a friend and ally in helping the world's most forgotten people.

He has expressed great concern that as little as 10 percent of medical research is devoted to diseases that cause perhaps 90 percent of the world's health problems, such as tuberculosis, HIV/AIDS, malaria and various intestinal maladies. Bill believes that with the right mix of funding and innovation his foundation can achieve breakthrough results in this battle.

In fact, since making its first global health grant in 1998, the Gates Foundation already has made a huge impact. It has helped save the lives of more than 670,000 children in the developing world through its support of an aggressive vaccination program. Yet Bill has set his sights much higher: preventing the deaths of millions of children a year. Such a goal requires new ideas, so his foundation offers grants to stimulate fresh thinking—for example, to try to come up with vaccines that need no refrigeration, or to try to alter the genetics of mosquitoes to kill or render them incapable of transmitting diseases such as malaria.

As a risk-taker, Bill is not afraid of failure. For example, those of us concerned about global health became excited in the late 1990s about the potential use of microbicides in the prevention of HIV/AIDS, which women could use to protect themselves even if their partners refuse to use condoms. However, a study in 2000 found that an early microbicide candidate, Nonoxynol-9, may actually increase the risk of HIV. The Gates Foundation responded to this setback by providing a $60 million grant in 2002 to push continued research and testing to overcome the problems in the early study, and today there are a number of promising microbicide candidates in development.

Bill sees his foundation as a catalyst, and he and Melinda carefully choose where to make grants that will have the greatest impact. For example, the foundation's $1.5 billion commitment to the Global Alliance for Vaccines and Immunization (GAVI) has not only enabled the organization to reach more than 80 million children with lifesaving vaccines, it has also helped GAVI raise significant new funding from other donors. In September, five European governments announced nearly $4 billion in new funding for GAVI over the next ten years. These donors, and others, are responding not only out of hope; they're also responding to Bill's track record in business and his increasing success in the global health field.

Bill's business instincts steer his foundation's direction. He knows what will motivate manufacturers to produce vaccines and medicines with limited commercial potential—limited because they target diseases plaguing primarily poor people. These manufacturers want reassurance that a distribution system will be in place once their investments in new vaccines emerge from the pipeline. He gives them that assurance—by sufficiently funding a program for a long-term commitment, by promoting long-range planning in countries that will benefit from the medicines, and then by helping these countries build a public health infrastructure.

Our two organizations mesh well in the programs we've undertaken jointly. We share a view that health interventions can have a multiplier effect on societies. Keeping people alive and healthy is a worthy goal in itself, but good health also keeps more children in school and farmers in their fields, which promotes a more active community life and a stronger economy. Sustainable economies require less financial assistance and, foreseeably, put an end to dependency.

While a major focus of the Gates Foundation's work has been delivering and developing vaccines, the foundation also supports The Carter Center's efforts to eradicate Guinea worm disease, which needs no vaccine. I've been impressed with Bill's understanding of what it takes to end that extremely disabling disease, caused by a parasite ingested in impure drinking water. Most business people want quick results, but stopping the transmission of the Guinea worm larvae to other human hosts takes time and is rife with uncertainty. Although we've reduced the number of cases by more than 99 percent to just 7,000 victims so far this year, who are mostly in two African countries, Ghana and Sudan, the last cases are the most crucial, difficult and costly to contain. Bill has translated his vision and optimism into tangible support for the eradication effort and challenged others to join him.

The foundation is also helping The Carter Center to realize the goal of eliminating river blindness disease from Latin America in this decade. River blindness is caused by parasites left by the bites of small black flies that breed in rapidly flowing streams; the parasites infect a victim's eyes, often leading to blindness.

In this case, medicine is the answer. We've determined that treating 85 percent of the half-million people at risk in the Americas with semiannual doses of ivermectin will halt transmission of the disease.

Bill likes the payoff from this initiative. But I would hate to imply that it's only Bill's intellect and business sensibilities that drive his philanthropy. It's his heart. "I believe the death of a child in the developing world is just as tragic as the death of a child in the developed world," I've heard him say. And if we can make sure that all people, no matter what country they live in, have the preventive care, vaccines and treatments they need to live a healthy life, he says, "it will be the best thing humanity has ever done." He adds: "I believe we can do this."

Bill and Melinda's foundation has set a major change in motion, elevating the potential of public health research and policy to improve life on earth. It has energized research into global health, made that work a credible career choice and attracted politicians to the cause. Perhaps most important, the confidence Bill has brought to the field has stimulated much more funding. As a result, we can see a day when sufficient resources are applied to global health to prevent the suffering and deaths of tens of millions of people.

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