Health and education are the capital which only pays off over the course of 20 years and will shape the next generation economy, said Bill Gates, co-founder of Microsoft and co-chair, Bill and Melinda Gates Foundation.
"If you do not get the health of your kids right, then even if you send them to school, they are not fully developed mentally or physically to be able to benefit from the education," Gates told CNBC-TV18 ahead of the launch of second Goalkeepers report.
Bill & Melinda Gates Foundation will present their second Goalkeepers report on Tuesday which tracks the performance of the 18 targets set out by the United Nations under the sustainable development goals (SDG).
Also Read: India needs to focus on boosting its agricultural exports, says Bill Gates
The report will share the data, celebrate successes and warn the global community about what could happen if we fail to continue investing in development.
Edited Excerpts: Let me start by talking to you about Goalkeepers Report which you first published in 2017. In the report, you said that there is more doubt than usual about the world’s commitment to development. Do you believe that there is less political will today to try and address the developmental needs of the world? Is it getting harder to pitch the case for developmental aid to developed economies?
Anytime you have that – 2008 financial crisis or Syrian civil war with lots of refugees – the world is going to get fairly short-term and think about dealing with those and countries can turn inward a bit when they are facing those challenges.
The long-term issues of getting rid of extreme poverty, solving climate change, innovating for farmers so that they can deal with new climate and still be themselves, these issues can get squeezed away.
Also Read: Aadhaar doesn't harm privacy, it merely gives an identity, says Bill Gates
We are glad that the United Nations has ambitious goals for 2030. We are glad that every year we get to say okay how are we doing Goalkeepers as a checkpoint and we often show what the results will be if we lose focus for, say HIV. If we stop working hard on the innovation and delivery or we show if we get more focused on girls education or reduction in malnutrition, some amazing things can happen.
So, yes, it is always a risk that countries are turning inward and certainly there are political leaders now that are more nationalistic than thinking about all of humanity.
Melinda Gates said that the Goalkeepers report was meant to be a wakeup call to leaders of certain countries. Has it got the attention of the leaders you were hoping to address? Are you seeing leaders take the development cause more seriously post the report?
I think it is impressive that the aid commitments have been maintained despite this wave of more inward-looking politics. The US maintained its aid levels, the UK was very generous -- all the way up to 0.7 percent. Germany’s aid budget has gone up, France is committed to increasing theirs.
Although we could always use more resources, in fact, these global causes, the innovation that will give us new tools whether it is vaccines or seeds or the science part, which is actually moving even faster than we would have expected.
On on-the-ground implementation, it is always quite a range. Goalkeepers we bring in people from Rwanda or Ethiopia who were getting ahead of the forecast and saying okay tell us how you did it and then we will take tougher areas like Northern Nigeria and say okay they are not fixing the permanent healthcare yet, what can all of us do to get it back on track.
You have spoken about how some of the SDG (sustainable development Goals) targets are realistic and some are aspirational. As you sit here today, which are the ones you where you believe that the deficit between reality and aspiration has been bridged significantly and hence more progress has been made? Where do you feel more confident today?
Our foundation, our deepest expertise is in agricultural output and health. On the health side, we made sure that the objectives were ones that there was a chance of being able to achieve and the world has gotten so smart about these health things, the new vaccines are being adopted, whether it is pneumococcus vaccine or rotavirus vaccine.
In fact, India is now in the process of now rolling that out over time to all the children. Africa is getting very close to achieving that goal. So health is the one that we are very deep into and it is very primal.
If you do not get the health of your kids right, then even if you send them to school, they are not fully developed mentally or physically to be able to benefit from that. So education and health are pretty special because that is the capital, that is your next generation, it only pays off over that 20 years but it is the primary thing that predicts what will happen to your economy in that next generation.
But do people get it because the concern is that when you invest in things like physical infrastructure, the results are perhaps quicker, more tangible as opposed to investing in education, knowledge and skills development which is the need of the hour. However, political leaders may go in for more short-term intervention as opposed to long-term measures which may pay off later. From a return on capital employed perspective when you have this conversation with political leaders, what do they?
Certainly, there is nothing wrong with infrastructure. Having roads is an absolutely amazing thing. There is a tendency to under-invest in the health of the poorest. As you said it does not pay off immediately, the child to death rate is rarely brought up during a political conversation and so the sustainable developmental goals are the tools to remind people that all these children surviving, all of these children grow up in a healthy way, how important that is. India is making progress on both health and the infrastructure.
But it has been a hard bargain to drive even in India, to get the government to agree to spend more on health. You have been waging that battle for a while.
Right. I would say the best progress has been on taking more risk and making sure that the quality of the system, the number of kids who get a vaccine that gets improved. I agree there is a limit on how far it can go and unless the public investment in these health issues increases. India is a lively democracy, people will debate about that thing, but when it is compared to other countries, the investment level probably does need to get more of a priority.
Have you looked at the Health insurance scheme (Aayushman Bharat) that Prime Minister Narendra Modi has announced? How that could impact India’s health goals?
We are working with Niti Aayog, talked about how other countries have brought in insurance, how they use private sector capacity to help in the health sector. There is some good long-term planning and over time this goal of having insurance more broadly is very important.
However, the affordability challenge means that the health sector will have to get more resources for you to get up to any substantial coverage level.
Let me talk about education because we have a Right to Education Act in India that is now a decade old. So while we may have addressed the enrollment challenge quite effectively, the quality of education continues to be a cause for concern. There seem to be no easy answers even globally. I think you talked about it in the report that the strategy to actually fix the education outcome is something that is yet to come together in any comprehensive way. What is the way forward when you look at India?
There are exemplars. A country like Vietnam which is substantially poor than India, if you look at the way that they train their teachers, insist that the teachers be good at doing their job, have lots of ways of measuring that, providing feedback, they are now at a level of education that is competitive with the richer countries and so it is quite an outlier.
India, as you said, has done well on access, including boys and girls having access, but the amount of learning, which is a recent thing to really measure, not just the attendance but the learning, India has a lot of room for improvement. In fact, given how much the Indian economy has grown, it has fallen behind on the quality of its learning outcomes.
Is this going to be a space that you would want to focus more on? Will education be a focus area for the Gates Foundation in India?
Our biggest spending on education by far is in our own country, the United States. Globally we have health and agriculture, in the US we have the education.
We are starting to take some of the lessons and be willing to share with governments that are interested. So we are working with the Central Square Foundation in India, we will be a partner helping share best practices for the Indian states that want to, they can get more learning taking place.
Since you spoke of agriculture, the challenge that we face in India today is that at one level you have record production but we have seen farm income decline over the last few years. How do you ensure that this promise that the government has made about doubling farm income is, in fact, the reality? Are there global examples that you have seen that are working effectively on the ground that could perhaps be incorporated into India as we move up the agri value chain?
A big reason that the Asian exemplars and China are by far the biggest that they are able to drive up economic growth was that they are able to make farm efficiency productivity for labour much higher and then that freed up labour that went into other activities. In their case, they have the right policies to be competitive in global manufacturing, they have the logistics, the infrastructure, the labour and land laws that created as the primary source of increased employment.
You do need that shift because otherwise, you would have to be seen as the cost of food would be going up very dramatically, that is not the goal, you want the urban poor to also be advancing at the same time.
There are some high value-added opportunities, there are some export opportunities but as you get improvement in productivity that labour shift is the only thing which can keep the per farmer income going up without having the food prices too high for the urban poor.
Labour is one of the challenges that you speak of in the report where significant progress has been made specially on poverty alleviation. But now you believe that it is going to be a challenge because it collides with the demographic reality and perhaps some of that is true for India as well. What is the way forward and how concerned are you today?
The world be it a very ambitious goal in reducing extreme poverty, it has gone down a lot, China was the biggest contributor to that, India was the second biggest contributor to that and so there are clear policies, getting kids in school, understanding malnutrition, which India has a whole mission organised on that which they are a lot smarter about how they can get those levels down.
So Asia as a whole with very few exceptions, like Yemen or Afghanistan, is on a track to take this extreme poverty and get it to a very low levels. Still a lot of learning to be done, China wants to go all the way to zero people in extreme poverty and it has an impressive programme to do it.
The place that is a concern is largely Africa. The population growth in Africa is very high, there is only a billion people today there but by the end of the century, that will be up to 4 billion. Most of the population growth in the entire planet is on the continent that is by far the poorest and so it is going to be a real challenge to keep making progress on extreme poverty unless we take the lessons from India and China and we are able to apply those in Africa, particularly in larger countries in Africa.
We could actually see a levelling now to even an increase to that extreme poverty number that we all want to see that get results.
So Africa looms in front of us, to get the young people into school, get a good education or they are well nourished, only if the world collectively takes their best lessons and helps Africa with that are we likely to get on the path where their incomes go up, their education goes up which actually means their population will grow quite as quickly, which makes the whole job a lot easier.
So on balance, last year you were candid about the fact that perhaps we would miss some of the SD targets? Do you feel a little more confident about meeting them today or do you feel that not much has changed in the last 12 months since the last report?
The year shows us that we are making very good progress on the health goals, shows us the kind of upstream innovation where we need new tools like a HIV vaccine, a TB vaccine, seeds that can deal with drought because of the climate change. I would say the innovation piece has gone faster than I would have expected, we will be sharing examples of that.
The global priority helping everyone including the poorest is always a little bit crowded out by near-term challenges. Whether it is brexit or the US trade policies and so we do worry that we only get sort of broad attention on these long-term goals during this one week and so getting out to people, where the generosity of the rich countries and better policies need to help out.
I think that is very important because the political commitment is certainly not guaranteed and it is possible that the issue of helping Africa or the poorest will get lost in all the other noise.
Since you are talking about the political commitment, any fresh conversations with President Donald Trump on these issues?
I haven’t seen him for a number of months. He has got a new secretary of state who I went in and talked to about Africa and about how we work with the US government.
What was the response?
The budget levels have been maintained and so the US role in HIV reduction, role in the malaria attack, there is a lot that the US has prioritised and continue to fund it at various generous levels in those areas. Over half the money that goes to Africa to help those problems comes out of the United States.
Will all these trade issues overwhelm that, how does that affect some of these very fragile economies, there is always a plenty to be worried about. So our voice on behalf of these poor countries that these policy choices would avoid creating damage to those most in need and we see that as a key role that we play.
About $15.5 billion over the last ten years has been spent by the Gates Foundation on the vaccine programme. What role do you see specifically for India from this perspective because it is a generic hub. We have the world’s largest vaccine manufacturer based in India as well, what specific role do you see for India from the vaccine programme perspective?
India, by keeping the quality with its drug regulation high, has been able to serve its own needs with very low cost vaccines, serum being a great example of that. But a lot of companies in India are at the forefront of very high volume, very low price vaccines.
We provided hundreds of millions of dollars to these organisations to help them build in factories, create new products, make sure that they are taking a very high volume, a low price approach and so it is fantastic India adopted the rotavirus vaccine and it has been over 20 years until a new adoption that happened, the pneumococcus vaccine is starting to be rolled out.
So if we look at the child survival rate that is improving quite a bit in India, this vaccine coverage deserves a fair bit of credit for that. A very high percentage of the world’s vaccines will be made in India. It is moving up so that it is even doing new vaccines, the high-quality rotavirus vaccine is a lower cost tool that one only be used in India and will also be used as a big vaccine in Africa.
What about sanitation which is Prime Minister Modis’ pet project? You have worked with the government on many levels on this front, what gives you confidence about the fact that we will be able to achieve the targets that we have been set out. Any idea specifically from India that you think is exportable?
We are partnering with Indian companies to either process the waste or eventually have a toilet that doesn’t create that waste and I do give the government a lot of credit. Most governments don’t talk about sanitation and it is a hidden problem. It is causing a lot of misery, causing a lot of disease, because the sanitation issue is quite poor in rural issue and in urban issue and you can see that in the rivers like the Ganges.
The idea is okay, are there incentives to process this sanitation? Even the railroad, what are they doing about these issues. It takes political leadership because you have to have capital investment, you have to say dumping sewage into the rivers is no longer going to be allowed.
We have a number of projects that are going on with new processing techniques, bringing in the cost of that processing down, we have our toilet fair in India where we showed some of those new innovations. Toilet fair later this year will be done in China because there are manufacturers and they are going to be making some of those pieces. So India and China are too big partners.
I know a lot of more progress to be made on sanitation because the government is speaking about it. It wouldn’t have been made without that big push.
We are talking a lot about youth and whether you have their health, their nutrition and education strong enough that they can make a big impact. Because of that delay, they only see 20 years later that you have done the right thing. It is often not invested in, not measured very well, the disciplined learning does not come in most countries, who is going to bring that up but it should be discussed, there is so much work to be done on that. So I take that idea of where the kids been born and are we going to invest in them and the impact that has, that is our biggest message for this year.
Let me ask you about what the focus areas are going to be for this year as we approach 2030 deadline for the SDGs, is there anything in specific that you want to spend the next 12 months focusing on?