9 February 2011

Africa: 'Best Chance' to End Polio - Bill Gates Promotes Vaccines and Food Programs to Attack Poverty

Photo: Gates Foundation
Polio vaccination in Nigeria.

Washington, DC — The likelihood that few African countries will meet any of the United Nations Millennium Development Goals, aimed at reducing severe poverty by 2015, has prompted a spate of studies, books and debates that examine development assistance. Many argue that aid, in general, has done more harm than good.

Since leaving an operational role at Microsoft in 2008, Bill Gates has devoted full time to the premise that international assistance, spent effectively, can make a critical difference in livelihoods. The Bill & Melinda Gates Foundation, founded by Gates and his wife, Melinda French Gates, possesses the largest assets of any U.S. grantmaking organization, according to the Foundation Center - some three times that of the next wealthiest, the Ford Foundation. The Gates Foundation's lead in annual donations is even larger. Warren Buffett's 2006 pledge of most of his shares in his Berkshire Hathaway investment firm effectively doubled the foundation's grantmaking capacity. The Bill & Melinda Gates Foundation describes its circle-closing approach to giving as a four-step process: develop strategy; make grants; measure progress; adjust strategy. Gauging effectiveness is built into the evaluation process, leading to areas of focus. In more than a decade of operations, a major constant has been the push to save children's lives through basic heath interventions in poor countries. Reducing hunger through agricultural innovations has become a theme of the global development program.

In his 2011 "annual letter" about the foundation's work, Bill Gates says the world's poorest won't be taking their case to world leaders, so he wants to help make their case for them "by describing the progress and potential I see in key areas of health and development." AllAfrica's Tami Hultman talked to him last week in Washington D.C. about his message.

The foundation is a major investor in food security projects in Africa. The British government has just released quite an alarming report, " The Future of Food and Farming ", calling for urgent action on the production and distribution of food, calling this a unique development in history. Do you see this as a moment of unique peril or unique opportunity, or both?

We need to take a long-term view of increasing productivity, particularly African productivity, because the world's going to need more food. It's kind of a wonderful thing that the needs of the smallholder farmer in Africa and the needs of the world line up. If we can get these farmers productive-enough seeds, get them the access to inputs and extension services, there's always a chance to create something that's self-sustaining. The demand is there.

There's no other place in the world where there's as much acreage that is low productivity as in Africa. My wife was in Ghana last week, seeing some of the projects we're involved with - some of which involve cocoa farming. They are getting trees that are four times more productive. Now they need credit to get the fertilizer, and they need information on how to do that. The world wants to buy those goods.

It's very clear that this is an alignment between what the world wants and what farmers need. Urban food prices have gone up a lot – and the 70% of the poor that are smallholder farmers, it's great for them.

A lot of things you can't do in a year. You need to start now. Over a five-year period for some of these interventions - and in some, if it's new seeds, maybe even a ten-year period - the opportunity to even triple productivity levels is definitely there.

You talked in our last conversation about the importance of an integrated approach for advances in health, for example in fighting malaria. Do you see the same thing in agriculture? For example, do there need to be international coalitions to coordinate work with farmers - and on food policies in general - to make it easier to earn money from those crops by selling them?

Well, you just need to help these farmers get their productivity up. Sometimes that involves infrastructure, like roads. Sometimes it involves agricultural research groups. We're actually using a pretty low-tech thing, where we use videotapes and DVDs of farmers talking to other farmers about best practices, as a way of doing the education.

The Alliance for a Green Revolution in Africa , under [former UN Secretary General] Kofi Annan's leadership, that's done very well. We have the project with the World Food Program (WFP) I mention in the letter. We gave them grants to use their expertise to help smallholders improve their quality in packaging and storage, so that they're able to compete to provide food for big buyers, including WFP. That lets WFP buy more food locally, get it out quicker, lower transport costs. So it's a win-win, where you have some spot in Africa that doesn't have enough food and somewhere else that has the food to sell. You're doing it within the continent, which is a new model.

USAID administrator Rajiv Shah says the aid agency sourced $250-million worth of food aid locally last year , up from zero a few years ago. What would happen if all bilateral and multilateral agencies tried to follow that example wherever food sources were available locally? Would that make a big difference? Or is there just too little available locally, and that's what you're trying to address on the ground by getting productivity up?

You don't want to abruptly switch and force everything into that mode, because some of the generosity you get in your food program comes from the fact that you're willing to take some of the output from rich countries. The world is doing a much better job striking a balance between local sourcing and global sourcing now than it did in the past. You have some extreme things - like Nigeria imports an immense amount of rice from Thailand. Well, what is it about Nigerian rice-growing that in terms of quality and productivity means that the county's not self-sufficient? That should be fixable, and there is some progress, but they're still a net importer.

So you don't have to deal with those local sourcing issues if you can just feed people right where they are?

Right. Africa should be able to feed itself and export, and amazingly that's not the case today. And the increase in urbanisation means that you've got to raise your productivity just to meet that goal.

You make the case in your letter that reducing the disease burden helps to meet all kinds of goals, including, I guess, food security - by reducing birth rate, raising IQs. That's not something we hear much talk about.

No, it's not promoted. The population growth challenges in Africa are really a bit scary. There are many positive trends in Africa, and I'm very excited about the progress. The thing that is tough is that even if average family size goes down, you're going to have a level of increase. But if we don't improve health, then you'll have an even greater increase. Tanzania's definitely going to be 90 million people, but if you don't focus on these health things it's going to be 150 million people.

It's kind of mind-blowing how challenging that is. Whether it's education or jobs, the quality of governance, stability - all of those things are within reach, if you don't have an exploding population. I don't know why it's not talked about more, because it's a very big deal. It has nothing to do with overriding anybody's choice or desire. This is all voluntary stuff. As you have more healthy children, it's just the choice in the family [to have fewer). It's good locally and globally.

You mentioned that one of the keys to Africa feeding itself is unused or underutilized land. At the same, there is a kind of land-rush in Africa, with investors buying large tracts of land. A report just published by the International Institute for Environment and Development in London expresses concern about the trend when there is lack of adequate scrutiny and little local benefit. But the report cited Liberia under President Eleanor Johnson Sirleaf as showing that carefully drawn contracts actually can be beneficial. Do you see any reason for optimism that these kinds of policy issues are going to get more attention and improve over the next few years?

Many of those land deals are beneficial, and it would be too bad if some were held back because of Western groups' ways of looking at things. Whenever somebody invests in Africa and actually builds infrastructure in Africa, they're the ones who are at risk. You can't take the infrastructure home! I'm not endorsing all these deals, but when capital is put into Africa, that's a good sign. Africa has to look at these things, but it shouldn't be viewed purely through Western eyes, because there's a real opportunity as the rest of the world looks to Africa.

So make sure they're reasonable, but don't reflexively react against them?

Yeah, there'd be a tendency to do that by people from outside the country.

You talk about polio in your letter this year and how close the world is to being able to eradicate it. Is that one of those things people could get excited about?

Absolutely! I'm very excited. It's the thing I'm spending more time on than anything. Nigeria was a place we haven't gotten rid of it. But now it's spread: Niger, Chad, Congo. We've got a number of places where we're pushing it down.

In Nigeria, the north is always a challenge, and we hope the election doesn't distract people. But it was a fantastic year in Nigeria. We've got more than 80% case reduction. That's a combination of both the priority that it was given by religious and political leaders and this more focused vaccine - mono-valent vaccine - that is more powerful. So it is a very positive trend. We've got a lot of energy about "Let's finish this thing".

That's quite a statistic: 80 % reduction in a year.

Unfortunately the numbers can jump up at you. This Congo outbreak is a great example of why you need to get to zero, because otherwise you'll just be spreading it back to any place that doesn't have very high vaccination levels. This is our best chance, and each of the African governments has to take this very seriously.

I'm now helping to make sure the money gets raised. The biggest donors are the US and our foundation and Rotary . But we got Abu Dhabi to put money up ; then the UK doubled their commitment to the polio campaign . So I think we'll be able to raise the budget.

It's amazing to think that only a couple decades ago there were 350,000 cases.

Yes, this would be a miracle - the second miracle after smallpox. And it would reinvigorate and energize the whole field of world health to take on the challenge of getting more new vaccines out and getting coverage rates up from the 70 % we have today to something closer to 90%.

So successes create hope, and that creates energy?

Well, we certainly saw that when smallpox was finished – the last case in 1977; declared eradication in '79. Right after that, Unicef took on the challenge of getting vaccination rates from 20% to over 70%. Africa had extremely low vaccination rates, and so a huge part of the increase - under the leadership [of former Unicef head] Jim Grant - was in Africa.

It's plateaued since then, which is better than falling off. But now we need to re-energize that. I see all the key actors – Gavi [the Global Alliance for Vaccines and Immunization], Unicef, WHO [World Health Organization] , people like ourselves – saying: "Let's get polio done! Let's get these vaccination rates up, and get rotavirus, pneumococcal, let's get them out there."

That's why I focus so much on it's not just the mortality benefits, although that alone should be enough. It's the fact that so many of the kids who survive are permanently damaged. I think if African governments understood that, they'd make this much more of a priority.

You talk about vaccines in general as magic.

Yes, it's the 2% of health spending that gives you the majority of all benefit in health interventions. If you're doing the right things on the kids under 28 days of age [the neonatal period that accounts for a large proportion of child deaths] - taking care of mothers and kids; doing vaccination right; and avoiding and reducing Aids - you can have great health, even in a fairly poor country.

I was struck by your figure that, in effect, for every $2000 reduction in effective vaccine spending, a child dies. That certainly seems a good rallying cry for public support. But what about policy makers, who are so stretched and confront impossible budget choices? How do you make the argument to somebody who's got to figure out how and whether to maintain the level of international assistance?

Well, you've got the example of the United Kingdom still increasing their foreign aid, up to 0.7% of GDP, even when they're having to cut everything else in their budget. The UK's been amazing. We hope a lot of people benefit from that example. We're not sure what's going to happen to aid levels in many places. There have been some cuts. Italy has cut more than anyone.

Everyone's got budget challenges, even the United States. So I'm doing my best to remind people that aid is not some amorphous thing, It's not palaces for [former Congo dictator] Mobutu. It's polio eradication, rotavirus vaccine and more productive seeds for food security and poor-farmer income.

You make the case that HIV/AIDS needs to have prevention as well as treatment. It's not something we hear a lot about any more, but it's still a huge issue.

Initially we thought, okay, we'll just make people aware of HIV. The Kaiser Foundation and our foundation funded a thing called LoveLife . [It was] the biggest billboard buyer in the country and raised awareness up to like 99%, but, unfortunately, the actual behavior change was very modest. So it's a challenge.

Male circumcision has come along as a very concrete thing. The demand is there; it's just that governments haven't scaled up the capacity – regulatory hurdles, not authorizing the very efficient ways for it to be done. Kenya's the only one that's moved to speed on that.

What do you see as the most important message that you're trying to convey, whether you're writing a letter or speaking to a group or to a journalist? What's the crux of what you're trying to communicate?

We can help all countries have the basic things we take for granted, in terms of nutrition and child health - and that allows them to be self-sufficient. It's a benefit to them - but also, in terms of stability and disease, it's a benefit to the whole world. We're on track for a lot of great improvements. We just need to make sure that we keep those investment levels, even in tough budget times.

Even though the pro-democracy movements across North Africa are focused on governance, a spark was certainly poverty, economic desperation. I think they're trying to make your case for you - that the world would be more stable if we would make these investments, and we would all be beneficiaries.

Yeah, Egypt's population went up faster than they were able to create economic opportunity. It's a good message of how you look at population growth and how you maximize economic opportunity.

And make long-term investments, as you say?

Almost all these things, if you think long-term, there are some highly leveraged ways to do it.

So you're optimistic?

Yes, I'm optimistic. Every year we'll have less children dying, less polio cases, better food productivity. As we improve things, the incremental steps aren't as noticeable as the occasional setback. But Africa is way better today than it was 20 years ago. There are a lot of good models for people to learn from.

The Bill and Melinda Gates Foundation is a contributor to the Development Reporting Fund of the AllAfrica Foundation.

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