When interesting people hang out, interesting things tend to happen. So when we found out that Steven Johnson, author of Where Good Ideas Come From and The Ghost Map was going to sit down and talk to Bill Gates, whom you’ve probably heard of, we thought we’d like to eavesdrop. So we did.
Gates and his eponymous foundation are launching the 10th year of their Grand Challenges initiative—a program that provides grants to projects looking to solve problems like malaria and malnutrition. Johnson’s most recent book, How We Got to Now, tackles the history and future of innovation, and is the basis of a six-part PBS series that launches on the 15th of this month. Over the course of their conversation, Johnson and Gates touched on everything from capitalism to ice. Here’s what they said.
Steven Johnson: I’m Steven Johnson, and I’m here at the Gates Foundation in Seattle with Bill Gates himself. And we are celebrating the 10th anniversary of the Grand Challenges. And we’re here to have a conversation about the Grand Challenges, and innovation more generally. Thank you for inviting me here.
I wanted to start by asking you about—kind of from a macro level—your career has been at the center of innovation, you know, from the very beginning. How would you characterize the difference between the kind of tech sector innovation that you were involved with and continue to be involved with at Microsoft, and what you see now and what you’re trying to do with the Foundation?
Bill Gates: Well they’re very similar in the sense that you pick scientists who have an idea about understanding something or inventing something, and you assemble that team and back them. As they move forward, you get feedback about things that are working and not working. You know, I think I enjoy working with engineers and scientists; I’ve enjoyed both roles.
Johnson: Yeah. There’s—some of the language—you’ve talked about kind of open innovation and open source innovation in the Grand Challenges and the Foundation. Tell me a little bit about that philosophy: What does that mean in practice?
Gates: Most innovation is capitalistic innovation. Where products and goods are created because somebody wants to be able to send their kid to school, wants to be able to eat that type of thing. Unfortunately when it comes to helping the poorest in the world, there is no market.
So a malaria vaccine would never be created without government or philanthropic things. Fortunately those things that are missed are not… Most diseases exist globally, and so even if things are initially invented for the rich world, they’re available and benefit everyone, like a measles vaccine. We get a lot of things—like the way toilets work—that get stuck, that is it’s so expensive and it never comes down in cost and can never be used in the poor world. Or you get a disease like malaria, that only philanthropy can go provide the literally billions that we will have spent by the time that gets solved.
Johnson: And sometimes it’s a question, right, of working outside the private sector to kind of begin to create some new platform that eventually becomes commercially viable?
Gates: Yeah, that’s a known—there’s two known market failures. One is that research is under-funded. Because particularly early stage research, the person taking the risk—the returns they can get are either nil or much smaller than the potential benefit. And then there’s working for the poor. So if you’re talking about innovation for the poorest, it’s the most under-funded thing. You won’t get there. And so the U.S. government is a great example of funding basic medical research. But then leaving it for rich world diseases, to the private sector companies that have all sorts of unique skills to go out and build the products. So we as a foundation end up partnering with biotech companies, pharma companies because a lot of the skill sets of making sure a medicine is safe, how you manufacture in a very low-cost way. Those only exist in the private sector.
Johnson: Right. One of the things I love about the Grand Challenges in particular is that they—this is kind of, I think, deliberate—echo of the things like the RSA premiums, the kind of challenges from the age in the Enlightenment, where a huge amount of new ideas that then ultimately became commercially viable ideas, industrial ideas, began with this organization that was just kind of offering these challenges to the wider public and saying, “Hey, we need to solve this problem. We need a red dye that is more stable that we can grow commercially here. We’re gonna give a prize,” like the longitude prize, is another example. That’s a really old tradition; I don’t think we—as a society, I don’t think we realize the importance of that as much? Is that your experience?
Gates: Well, I don’t know how much prizes—the longitude prize is I think fairly unusual. Most innovation—you think about clothing, food, transport—most was done on a purely commercial basis.
Trains, cars, steam engines. A lot of those things. Now you have tinkers who often lay the foundation for the understanding, and that—you know, it used to be harder to tell who was the product person and who was the basic research person. And as medicine’s gotten more complicated, there is a whole field of endeavor that really is pretty basic stuff. And then the stuff in between we talk about as translational.
Johnson: Right. I mean, it was—one of the things I notice is just the diversity of the kinds of fields that the Challenges have funded. I mean, you have everything from astrophysicists to car mechanics who are in there. So that tinker tradition is still part of that goal, right?
Gates: Yeah, if you give people only a hundred thousand, which is that Grand Challenge exploration grant, but that’s actually numerically the one we give the most. They really have to be moonlighting to do that. They have to be using a lab that’s founded by some, something else. You know, trying it out at night. Now if they can show result, then they’ll be funded for their day job, at a 2 million to 5 million-dollar level.
But yes, they have to have almost a personal passion for their idea, to want to prove it out, in that first phase. We’re drawing in IQ from so many different fields, once we frame that problem really well. Because some of these problems—like delivering a baby or keeping a vaccine cold—they’re not really biological problems. And so the normal people who think about development may not understand in the refrigeration case that there’s been an invention of materials that prevent or reduce heat leak so dramatically that an approach of keeping them cold without any new energy inputted. A thermos-type approach could actually work.
Johnson: I saw some of that today, and it was so amazing because one of the stories that I was just writing about and that we have on this new TV show is about the early days of the ice trade in the United States. This guy Frederick Tudor, who came up with the idea, a very commercial idea—although an insane idea as well—that you could take blocks of frozen lake water and ship them all the way to India or to Rio. And, you know, take cold and bring it to the hot climates of the world. And he ultimately made a fortune in the middle of the 19th Century doing that. And what I saw today was this device that enables you to keep vaccines cold for up to five or six weeks, right?
Johnson: Just basically with ice; I mean you’ve got the insulation to keep the ice from melting. So, there was this beautiful kind of symmetry; in fact, Tudor would have loved it. That that technology is still around, based around ice, is pretty amazing.
Gates: Yeah, ice—it takes a lot of energy to melt ice, and so if you keep the heat leak very low, then you get that very long lifetime. And in these developing countries, the idea of going out and getting propane, or getting electricity: That’s proven to be so unreliable and so expensive that we often lose vaccines.
Johnson: And one of the things that, you know, you see again and again through the history of innovation is: Someone solves a particular problem, but it ends up triggering a set of unanticipated consequences. Sometimes opening up new doors, sometimes creating new kind of secondary problems. Do you think about that on a foundation level? I mean, you’re so beautifully focused on solving these clear problems that are urgent problems around the world. How much of those secondary effects are in your kind field of vision?
Gates: Well, a lot of the grants we give that don’t end up creating a breakthrough product, we are building capacity in the field. We’re understanding how to do these trials. We’re funding people in the developing countries themselves. There are some mysteries that are very important to us, like how do we make sure that a child’s brain develops properly? That their body develops properly? We’re making a lot of progress cutting the deaths down. A lot to be done, but you know, just since we’ve been in existence, we’ve gone from 10 million a year to 6 million a year.
There’s—and we can see a path to get that down even as low as 2 million. On what they call “morbidity,” where you survive but you’re damaged because of the ill health and nutrition—that we don’t understand nearly as well. And it’s an awful thing, it’s really a key element of the poverty trap, that a country without help just doesn’t have the skills, even if you try and invest in education, to get itself up to self-sufficiency. So you’ve gotta help reduce disease, burden, get the diets to be better. And then, you know, great things happen like we’ve seen in so many countries.
Johnson: And that’s related to the—there are three new challenges that are being announced basically today. You wanna talk about those?
Gates: Yeah, so the first is the continued interventions for health. Which is a lot like the original ones. You know, we still have a number of infectious diseases: We need better vaccines, cheaper vaccines. So we’re continuing that.
Then we added two that have a slightly different flavor. One focused on women and girls and how we can reach them, communicate with them. And then one on these childhood issues, particularly the first 30 days, where there’s been less progress on the deaths that take place there. They’re in some ways less identifiable than malaria or pneumonia or diarrhea, which are the big killers once you get in that 30-day to five-year period. So we’re, you know, opening up some new frontiers. Slightly more complicated, but—you know, very timely.
Johnson: Yeah. And exciting. And how do you decide—with the big kind of questions—like well these are the three new areas we’re gonna open up? What’s the decision-making process for that?
Gates: Well, the basic goal is to say that because we think all lives have equal value, a child born in a poor country at age 5 should be alive like they are in countries that are better off. And they should have a chance to achieve their potential—that is their brain, their body should be fully developed. And so anything that—set of partnerships, set of challenges that can help us reduce that unbelievable gap. You know, in the case of death, you know, Nigeria, 15 percent of the kids die before the age of 5. There’s a few places left that are 20 percent. In richer countries it’s well under 1 percent of the kids. And so, you know, that’s gotta change. It’s just very inequitable that the work hasn’t been done. And it’s mostly infectious disease.
For the things where you’re alive but not as capable, understanding how much of that is diet versus sickness, and how do we in a cost-effective way intervene in that. There’s still a lot of missing understanding there, but we wanna gain that understanding and go out and completely solve that.
Johnson: And is there a specific project that you’re particularly excited about? An innovation you think is really promising, or…?
Gates: You know, we work in so many different disease areas—the idea of taking malaria and country by country doing local eradications: We’re very enthused about that because we have new tools and new models, new understanding. We wanna finish the polio eradication, which we’re fairly close on.
You know, it’s tough ‘cause the last few countries are gonna be the most difficult countries. And it’s Nigeria and Pakistan are the two where we’ve never gotten zero cases.
But particularly in Nigeria, we think we’re getting very, very close to that. So ideally we’d get polio done. Then have—
Johnson: Check that box.
Johnson: Check the polio box.
Gates: Then have new tools, and then really start down the path of taking that malaria map and slowly but surely shrinking it to eventually getting that down to zero.
Johnson: One last question: You and I are both very optimistic about the long view of progress. Why do you think most people aren’t? Right, why do you think there is this kind of general feeling? You see it in so many different things where people are just like, “Well, things were better 50 years ago, back in the day.” I mean, where does that lack of faith in progress come from?
Gates: Well, in a sense we’re attuned to think about problems, you know, what might go wrong, what is the problem. And the things like, "Oh, I’ve got a toilet.” You know, should I celebrate? I’ve got nutrition; should I celebrate?
I’ve got nice clothes. I learned to read. I get to watch more shows. You know, just take access to music, now versus in the past. Or even social issues, where society—including gender inequality—we’ve really made progress. We say, “Of course!” You know, we take that for granted. You know, the Pinker book, Better Angels of Our Nature, talks about how the only thing that improves faster than violence reduction is our distaste for violence. So that we’re constantly saying, "Hey, we think this is the most violent time ever," because our willingness to put up with it is so low. And so I think the idea that people are worried about problems, like climate change or terrorism or these challenges of the future, that’s okay. But boy, they really lose perspective of what’s happened over the last few hundred years. And how science and innovation have been a central factor of that.
And I think that’s too bad, because people are lucky to live now. And they should see that that progress is actually taking place faster during their lives than at any time in history.
Johnson: And celebrating that kind of innovation, and telling those stories, and then supporting new stories as they’re getting developed: That’s a great goal, and a great foundation to do it. So thank you for everything you’re doing. And congratulations.
Gates: Thank you.
Johnson: Thanks, Bill.