Bill Gates: Why is the US so mean about fighting Aids?

From a speech given by the founder of Microsoft at the Ninth Annual Retrovirus Conference, in Washington DC

So how did I get interested in medicine? Well, it's a bit of a circuitous path. I started out poorly because my biology teacher in high school made biology very uninteresting. I didn't like dissecting frogs, or test tubes; it all seemed too hands-on from my point of view.

So how did I get interested in medicine? Well, it's a bit of a circuitous path. I started out poorly because my biology teacher in high school made biology very uninteresting. I didn't like dissecting frogs, or test tubes; it all seemed too hands-on from my point of view.

So then about, oh, six or seven years ago, I was thinking about philanthropy and what areas in science needed to be funded. I thought about human priorities, and decided that health was probably the thing of greatest importance, and that issues relating to population growth would have the most dramatic effect in terms of resources in all dimensions – the environment, education, healthcare. If you can reduce population growth, if you can stabilise it, that would be the most effective. And so the early work of the Gates Foundation was mostly in the area of making sure people had access to information on family size and what their options were.

Because of that involvement I got to know people who worked in world health. One of the documents that I still remember, and which struck me pretty dramatically, was the World Development Report in 1993. It comprehensively chronicled how different health conditions in the world at large are from conditions in the rich countries, particularly the United States. It was very striking to me, because they took, as the World Bank should, a fairly numeric approach, but every page screamed out that human life was not being treated as being nearly as valuable in the world at large as it should be.

Through that reading, I got to meet more people in this field, and the two things that really emerged as priorities are work in vaccination and work in Aids. Some anecdotes really just stun me; for example, I'm told that in South Africa, death certificates never mention Aids.

I was at the World Economic Forum a few weeks ago, and really pushing to ask whether we are sharing our largesse, our good luck, in an appropriate way with the entire world.

And that's what a lot of so-called "anti-globalisation" protests are about. It's not about saying let's go back to a hundred years ago, but rather asking on what basis are things shared as we move forward. And certainly there's an area where the US and others could put their best foot forward, and that is by addressing Aids health issue in a dramatic way, with action and resources.

There are a number of other countries that are willing to step up what they give in terms of aid, but it's tough for them politically because, on really any measure that you use – per capita, per GDP – the US is the least generous in some of these areas. It's very tough for them to go in and say, "Okay, let's get up to 0.3 per cent of GDP" if the US is going to stay down at 0.1 per cent.

There is a paradox here, because anyone who actually sees what's going on in some of these countries would certainly say, "Yes, I would like to personally give and would like my government get more involved in giving to these activities."

We have to believe that it is really this lack of visibility that is holding things back as far as tackling Aids is concerned. My analogy is that if we took the world and re-sorted all the neighbourhoods so that they were in random locations, so that most of the neighbourhoods that you would live next to would reflect the average living conditions in the world at large, then these problems would get addressed. They'd get addressed on purely humanitarian grounds.

Well, there are a lot of attempts to justify these efforts on other grounds. But it seems unusual to me that they have to be justified on economic grounds or military grounds or on any grounds other than the humanitarian. Something of this importance is worthy of our attention, whatever seems to make sense around it.