You could argue that our failure to focus on what’s getting better suggests that the media generally is missing an enormous story. News by its nature is about a surprise. Which day do you cover malaria deaths being cut in half? Which day do you cover workplace accidents down by a factor of 50 over the 50-year period? It’s society doing what it’s supposed to do. People’s standards change. When I first went to Africa, I talked about how a single child dying was such a big deal because in the U.S., it’s rare. In some parts of Africa, because the death rate was so high, people actually waited to name their babies until they were 4 months old. And so the higher expectation is a good thing but it makes you feel that we’re still falling so far short.
You decided to focus on public health. Can you talk a little about what has surprised you most? Our global health work has exceeded our expectations. Being part of this movement, which has gotten childhood deaths down from over 12 million a year to about 5 million a year now, going from 1990 until today, and with a goal to get it below 2.5 million by 2030, cut it in half again.
What turned out to be harder than you bargained for? The death rate from AIDS and preventing mother-to-child transmission during birth, those things have gone super well. But the prevention, getting people to change their behavior and getting the vaccine or drug that would protect you, that has not succeeded.
What’s the argument you make to the unemployed worker in Ohio about why the government should be spending money on foreign aid? The development aid we provide helps stabilize the world and lifts these countries up so they can be self-sufficient. And our aid is less than 1% of the U.S. budget. So the question is, In helping to stabilize 95% of the world and prevent epidemics that would come and hit the U.S., is it a priority to spend 1% of the budget for those 95% and keep 99% of the budget for us who are a bit less than 5% of the world’s population?
The payback to U.S. foreign aid: getting rid of smallpox; on the verge of getting rid of polio; lifting up countries like South Korea, which was a huge aid recipient.
So the benefits of what we’ve done are quite phenomenal. We did a forecast that showed that a 10% cut in HIV spending would, between now and 2030, cause 5 million more deaths, because the U.S. has been so key to keeping this infectious disease in check. To reduce the money now would be horrific if killing 5 million people can be described that way.
You added a focus on pandemics this year. Of all the major bad things that could happen—a nuclear war, an asteroid, a gigantic earthquake—the one that’s the most scary is a big epidemic, like a flu epidemic sweeping the world as it did in 1918. And so helping poor countries so they would detect it early—and they’d have the capacity to stop it when the numbers are very, very small—is advantageous to the entire world.
The experts that understand this stuff the best are at the U.S. Centers for Disease Control and Prevention, and so keeping them funded so they can work with these countries—that is not just a benefit to these countries. That’s very important to us.
In the case of Ebola, because it wasn’t caught early, the U.S. had to spend a lot of money, including deploying the U.S. military while some people from the CDC went in and did heroic work. In fact, a lot of polio workers were involved in making sure it was contained to the three countries.
That’s a big success, but there will be many more like that that could be worse. The speed of infection of a flu is 20 times faster than Ebola, so some disease could go global if you took as long to figure out what was going on as we did with Ebola.
Some of the things you’re talking about feel like traditionally the realm of government, and yet people’s faith in government to solve some of these problems isn’t so great. Government is responsible for these things, and so the big money is with government. It’s over 10 times bigger than all philanthropic things put together. The role of philanthropy will often be to fund pilot approaches, to find breakthrough approaches. Funding all these young people who think they have a new approach for an HIV vaccine. Philanthropy is a very strong complement to the government in that.
Is it easier for you to fund something that’s far-fetched? I think so. Government has four-year, eight-year cycles, and the U.S. government actually is the best government in the world when it comes to funding medical research, but even they aren’t going to reach out to some wild new approach quite the way philanthropy can. So the two really do go hand in hand.
Almost everything our foundation does is in partnership with the U.S. government. I wish other governments were as enlightened. Then again, that research investment in the U.S. has led to lots of successful companies and big break- throughs, so I think it’s definitely a smart thing.
Philanthropy will never take over the role of government. Making sure every child has food and education, that’s governmental.
If you had a billion dollars, which you do, to invest in clean energy, where would you put it? We’re trying to foster breakthroughs so that clean energy is actually cheaper than today’s hydrocarbon energy and make it so it’s not how much are you willing to give up to have clean energy—which in a place like India, where getting electricity means air conditioning or refrigeration and all the things we take for granted, including saving lots of lives—asking them to pay a premium and therefore electrify slower than they would, that’s a very hard trade-off.
You’ve thought a great deal about artificial intelligence, which terrifies many people in terms of what it means for their own prospects. What makes you optimistic about the role technology has been playing in the future of work, for instance? There are many problems that we haven’t solved. Obesity, diabetes, Alzheimer’s: these are gigantic problems that there are solutions for. And I do expect that advanced software—AI software—will help us understand the biology, understand how to intervene and improve lives very dramatically.
AI is going to be changing the job market, but in market capitalism, there are always big changes, as long as we have a good safety net for the people who have been trained, whose skills don’t apply going forward. Particularly if they are late in their career, then holding back innovation is not the best path.
What are some of the things you don’t think machines are ever going to be able to do? Computers are still very weak when it comes to understanding. They can’t process a textbook and use the knowledge the way humans do. But that’s being worked on. There’s no real problem- solving limit to what can be done. Understanding what does it mean in terms of consciousness or anything like that, I know that the software won’t be in that realm at all. But it will be an incredible problem solver.
I’m a parent, you’re a parent. Is there a way to envision a machine that could have an easier time parenting than your typical parent? Parenting—there, a lot of the value is that human caring and willingness to make time. Sympathy. And so those are domains that are not in traditional problem-solving.
And so the hope for now will be to get the machine to help us discover new drugs, to help us make traffic not as bad, rather than substituting for those human-type things. Hopefully, they’ll free up time so we can enjoy more time for parenting.
Do you worry about the amount of time that either you or all of our kids spend on the screen? Well, certainly you can do a lot of things on your screen, some of which, like playing the same video game again and again, that’s not well- balanced. It’s probably not going to develop your capacity fully.
There needs to be discipline. Anytime we give somebody a new tool, like when Microsoft Windows had lots of fonts, there were a few years that people used way too many fonts and thought it was very clever. Now people have kind of calmed down. It’s kind of rare if somebody is goofing around using some new font.
The discipline about when a family’s at the table: Is the phone allowed to buzz or not? When you do your homework, what do you do? When a kid goes to bed at night, we say, Hey, the phone’s on the charger, which happens to be outside your bedroom. So it’s a visible fact that you put it there.
Speaking of discipline, how are you able to find the time to read so much? It’s very relaxing for me. I do a lot of work, and it’s kind of this reward. But I have to be careful. Amazon or Netflix video watching can actually cut into my book time. There’s been a few months when I’ve looked back and said, “Gee, I didn’t read as many books this month. Oh, well, we were watching three seasons of The Americans.”
Which world leaders today make you optimistic? There are some amazing leaders, like Chancellor Angela Merkel in Germany. She got a lot of criticism for bringing in refugees. She’s been a great leader in terms of thinking about the world and having a good, calm view of things.
Leadership in India has been quite good. There’s a lot of things about reforming the country and getting it to be a bit less socialistic and trying to get things moving, so they tap their potential.
There’s no Nelson Mandela, where there’s somebody who took a country and did something where we completely wouldn’t have expected that to take place.
Indonesia has good leadership. In a lot of the African countries that traditionally had sort of tribal thinking, which doesn’t run the country well, there’s been a slight increase in the number of democracies.
What do you think about for the relative absence of women, both in C-suites and in leadership positions? It’s interesting. There are areas of phenomenal progress.
So in college, there are more women than men. In law school, in medical school, it either slightly favors women or it’s pretty equal.
There are some domains like the hard sciences, including computer science, and government and corporate leadership, where the numbers aren’t nearly that large.
Yes, you can say there’s a delay factor that, O.K., you have to wait 20 years from when business school is equal before you get the impact, but it’s not proceeding as quickly as that would suggest.
So is it about maternity leave, is it about discrimination, is it about our model of what a great leader-manager looks like? We’re making progress.
Every one of these figures is going up, though a few feel like they’ve plateaued at a level way below where we’d like to see them get to.
So after this experience, do you think you would like to be a magazine editor?
This idea that people trust someone to pick interesting things, kind of stimulate them and take them outside of what they would run into if they did it à la carte, I think that’s so important.
I hope the world takes this personalization, which we’re in the very early stage of, and goes back to saying, “No, having an editor is a great thing.”