Philanthropist Bill Gates talks public health, biotech, and the race for the White House

Bill Gates became one of the richest men in history after cofounding Microsoft. His impact on the world of personal computing cannot be overstated.

But for more than 15 years, he has devoted himself to philanthropic work through the Bill & Melinda Gates Foundation. He is passionate about combating health inequities and diseases of poverty in developing countries. He has played a key role in wrestling polio to the verge of extinction; another major global health scourge, malaria, is in his sights.

Gates, 60, is arguably Harvard’s most famous dropout, but he was back in Boston on Thursday to speak at the opening session of the American Society of Microbiology’s annual scientific conference, Microbe.

Before that event, Gates met at a downtown hotel with STAT executive editor Rick Berke and Helen Branswell, STAT’s senior infectious diseases and global health reporter. They discussed everything from Gates’s deep interest in science to his views of a presidential race in which the Republican nominee has suggested, despite all scientific evidence to the contrary, that vaccines may be tied to autism.

The following is a condensed version of the conversation, edited for brevity and clarity.

We heard that you met with some scientists here to have some one-on-ones. We’re curious about your personal interest in science.

It’s a very fun part of my job. Last week, I met with people from the Wyss Institute and Synlogic. Today I met with Editas. I went to Intarcia.

I’m over at the Broad [Institute] a lot. And, you know, biology is moving at high speed, fortunately for Boston. It’s moving at slightly higher speed here than anywhere else. It’s incredible to see places like the Broad, the Wyss, and then all the companies that are here doing great work.

When you meet with these companies, do you ask them specific questions?

I read a lot of papers in advance. So take Editas as an example — Feng Zhang, David Liu. They’re there and they’re talking about the latest in CRISPR. They have some new endonucleases. We’re taking the diseases they’ve decided to target and understanding how they see the regulatory pathway.

It’s really nice that I get to meet with a lot of those top companies. Some of those people we’re doing grants with, some people we’re not. We’re just trying to understand the latest in the technology.

One thing that we hear a lot about is billionaires spending money to cure cancer. Is there almost too much money going to cancer and not enough to other public health issues?

Well, philanthropy, the beauty of it is its diversity. People get to give to things that they’re passionate about.

If people want to give to cancer, if that’s the thing they’ve seen an effect on, there are effective ways to do it.

Government research in the case of cancer — that’s the big number. I think NCI [the National Cancer Institute] is up at a little over $6 billion a year. But that doesn’t mean that somebody who is funding younger investigators or more unusual approaches — sometimes that really makes a huge difference.

What do you think of Vice President Biden’s “moonshot“?

Anything that gets us more money for medical research is a good thing. I don’t know about that construct specifically. There’s always a tendency in the slogans we use in health to potentially overpromise.

But people need to get excited. We had the war on cancer, you know cancer has won several rounds of that war …

What’s going on with cancer in general right now … it is a very, very exciting time in cancer — whether it’s immunotherapy, antibodies, basic molecular understandings.

You paused and almost rolled your eyes when I mentioned the “moonshot.” Do you think that that’s oversold?

The idea of getting people excited about the progress that is being made and can be made is a great thing. I’m always a little cautious about telling people what will necessarily come out of these things because the patience required is very, very high. The Siddhartha Mukherjee book [“The Emperor of All Maladies”] talks about how many times during the history of cancer people thought, okay, surgery, or we’ve got a chemist, or radiation — we’ve got it.

But this time, I think if you take a 20-year time frame, we will see some very, very dramatic reduction. And most diseases, including the infectious diseases that we focus on, there’s a lot to be optimistic about.

There’s a few things where you get a slogan like “AIDS-free generation.” … I wish that were more likely. Truthfully, because we don’t have a vaccine, and the prophylactic tools, the compliance of those things has been very poor. We actually run a risk that the next generation will have more AIDS than previous generations.

It’s a story with mostly positive elements, but if you say simplistically we are on the path toward an AIDS-free generation, no, we’re not. We need more R&D, more tools. And if you’re not careful, if you overpromise, you do get this fatigue, and then, even when you still need the resources, people don’t come in.

But getting more interest, excitement about what’s going on in medical sciences — that’s fantastic.

That provides a great segue to polio. When you got into polio [eradication], when exactly was that?

We were giving at a reasonable level in like 2003, 2005. The time that we become the biggest funder? [It was 2007.] It was when things, in some respects, didn’t look too good.

There was a real concern that it was going to fail. When you got into this, did you think it was going to take as long as it’s taking?

Who knows how long it’s going to take? Things have actually gone pretty well the last several years. Even right now, I’m talking to politicians in Pakistan, army people in Pakistan, President Ghani in Afghanistan. We’re working super hard.

When we came in, our team said, ‘Hey, we’ve been spending like $50 million a year, we need $100 million a year.’ I looked at it and I said ‘Hey, that’s not true. You’re asking for $100 million because you’re not brave enough to say what it’s really going to take to do this thing. You think a doubling is the most you might get, and that gives us the greatest probability of doing it, but in fact, to really have a reasonable probability of doing it, we need to raise a lot more money, not just from the foundation but from other donors.’ We, along with Rotary and other partners, decided we needed to take the whole thing to a different level. Polio spending went up quite a bit.

When we first came in, we would have said the last two places in the world that polio would be would be Nigeria and India, and then maybe Somalia. We wouldn’t have predicted [Pakistan and Afghanistan]. … But boy, polio is a hard disease. It has characteristics that make it way harder to eradicate than smallpox.

What will it take to get it over the line?

With good execution in Pakistan-Afghanistan, which we think we’re getting, with a bit of luck, the last wild-type case will be some time in 2017, and then we start a three-year clock for eradication.

Do you have a bet with Jimmy Carter about whose disease is going to be eradicated?

We’re the primary funder of Guinea worm also.

So you win either way? And the world wins.

When you’re doing disease eradications, there are some diseases like polio where if you mess up, it could come back in a big way. Guinea worm is never coming back in a big way. Certifying it’s at zero may take some years here. … The magic number zero, predicting how many years that is, how much money you put into surveillance is a bit tricky. But it’s on its way to a success. Hopefully, President Carter will be there when we hit that zero.

We also want to talk to you a little about Zika. The CDC said today that they’ve already recorded six pregnancies in the United States in which Zika birth defects were seen. What do you think the US ought to be doing differently?

We’re going to get surprises about diseases. Although in general, I think global health should be more funded and emergency preparation should be more funded. Even if the thing was funded at some higher level that I might pick, the risk of some new pathogen showing up — you’re never going to be completely immune to this. This one is particularly surprising because it’s actually a pathogen seen ages ago, and it wasn’t believed to be pathogenic.

You’re so passionate on these issues of public health, how would you compare a President Clinton and President Trump on these issues?

We have had a great relationship with all administrations so far. The Bush administration initiated PEPFAR [President’s Emergency Plan For AIDS Relief], which is a miraculous, amazing program that has had bipartisan support. The Bush administration started the President’s Malaria Initiative — they picked a great leader, it’s been a huge thing, it’s perhaps why many fewer children die from malaria [than] in the past. Then we have the foundation to start to talk about regional eradication.

The Obama administration has also been fantastic to work with because they cared a lot about global health. They haven’t been able to push the budget up as much. But these are tight budget times. They didn’t get to push the budget up on much of anything, but they picked good people, and they’ve been very serious, and there’ve been some new initiatives. I do think the way the US government stepped in on Ebola was extremely beneficial to the world. There was a lot of good work done there particularly by CDC, but not just CDC.

We approach any new administration with a positive, open mind.

You’ve worked closely with the Clinton Foundation. Are you confident Trump understands these issues?

[Smiles broadly.] There have been questions about vaccines in general where some of the candidates have shown that they’re not as up to date about vaccines in general, and that’s got to be a concern. Science in general, whether it’s GMOs or vaccines, there’s a lot of people out there who don’t give science the benefit of the doubt.

In terms of experience, Hillary Clinton and Bill Clinton have more experience on global health.

These causes are so important there’s nothing that causes you to change your total commitment. Polio, HIV, malaria, we’re going to work with whoever’s elected.