The U.S. spends $8 billion a year on global health — only a fraction of 1 percent of its total budget, but five times more than what the Bill and Melinda Gates Foundation spends.
"So we often work together," Bill Gates tells NPR's Steve Inskeep. "Only by having that large amount of resources, the government expertise, and the U.S. government setting an example for other rich governments — that's the only way the global health endeavor has managed to be so successful."
Finding Practical Ways To Help
Asked how the Gates Foundation sorts through myriad medical and political debates to direct its money, Melinda Gates says she and her husband have faith that biotechnology and vaccines can eradicate diseases like AIDS.
An AIDS vaccine is their long-term goal, she says, "but given that we don't have a vaccine, what other pieces do we invest in today to make sure we prevent the disease as much as we can?"
The foundation must also consider the conditions in the countries it's trying to help.
"You have to pick appropriate technologies that will work in the developing world," she says, citing as an example the foundation's efforts — unsuccessful, so far — to create a microbicide that would protect women from sexually transmitted diseases.
Can Aid Harm Weak Economies?
Recently, critics have spoken against providing certain types of aid to Africa, arguing that it can perpetuate, instead of solve, problems.
For instance, economist Dambisa Moyo has said that the Gates Foundation's shipping of mosquito nets to African countries that could make the nets themselves does more than prevent malaria — it also makes the countries dependent on Western aid.
Producing the mosquito nets in Africa instead of importing them, Moyo says, would develop the local economy and raise the standard of living.
"I think it's pretty outrageous to say that you ought to wait some years to create a few hundred jobs, and let hundreds of thousands of children die," Bill Gates says.
"The first intervention is to get health to be reasonable," he says. "Health aid is something that allows a country to get on its feet."
For example, the mosquito nets not only help prevent malaria, they also allow parents to focus on their livelihood instead of tending to a sick child, Melinda Gates says.
The Importance Of Details
Still, the Gateses acknowledge that providing aid to developing countries is not always easy — or successful.
"Sometimes you make a mistake where it's a fantastic investment, but there's a little piece of it you didn't get right," Melinda Gates says, citing the foundation's efforts to provide a rotavirus vaccine to combat diarrhea in Nicaragua.
She calls it "an amazing, lifesaving vaccine" for kids.
There was just one problem: "You have to keep the vaccine cold, all the way up until it gets into the kid's mouth or arm," which is a challenge in warm climates like Nicaragua, India and Africa.
The rotavirus vaccine must be transported in a refrigerated environment and often, for the last mile or so, in a cooler.
Making things worse, the vaccine's packaging was too large and cumbersome to be carried efficiently. So the project was delayed as the vials and their packaging were made smaller.
"You just learn from it," Melinda Gates says. "You just say, 'OK, that's a small mistake we made. We're not going to make that mistake again.' "
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