ravage the civilian population most. The world will be entirely flat only when all these people are brought into it. One of the few people with enough dollars to make a difference who has stepped up to this challenge is Microsoft chairman Bill Gates, whose $27 billion Bill and Melinda Gates Foundation has focused on this huge, disease-ravaged, opportunity-deprived population. I have been a critic of some of Microsoft's business practices over the years, and I do not regret one word I have written about some of its anticompetitive tactics. But I have been impressed by Gates's personal commitment of money and energy to address the unflat world. Both times I spoke to Gates, this is the subject he wanted to talk about most and addressed with the most passion.
“No one funds things for that other 3 billion,” said Gates. “Someone estimated that the cost of saving a life in the U.S. is $5 or $6 million– that is how much our society is willing to spend. You can save a life outside of the U.S. for less than $100. But how many people want to make that investment?
“If it was just a matter of time,” Gates continued, “you know, give it twenty or thirty years and the others will be there, then it would be great to declare that the whole world is flat. But the fact is, there is a trap that these 3 billion are caught in, and they may never get into the virtuous cycle of more education, more health, more capitalism, more rule of law, more wealth... I am worried that it could just be half the world that is flat and it stays that way.”
Take malaria, a disease caused by a parasite carried by mosquitoes. It is the greatest killer of mothers on the planet right now. While virtually no one dies of malaria today in the flat world, more than 1 million people die from this disease each year in the unflat world, about seven hundred thousand of them children, most of them in Africa. Deaths from malaria have actually doubled in the last twenty years because mosquitoes have become resistant to many antimalarial drugs, and commercial drug companies have not invested much in new antimalarial vaccines because they believe there is no profitable market for them. If this crisis were happening in a flat country, noted Gates, the system would work: Government would do what it needed to do to contain the disease, pharmaceutical companies would do what they needed to do to get the drugs to market, schools would educate young people about preventive measures, and the problem would be licked. “But this nice response works only when the people who have the problem also have some money,” said Gates. When the Gates Foundation issued a $50 million grant to combat malaria, he added, “people said we just doubled the amount of money [worldwide] going to fight malaria... When the people who have the need don't have the money, it takes outside groups and charities to get them to the point where the system can kick in for them.”
Up to now, though, argued Gates, “we have not given these people a chance [to be in the flat world]. The kid who is connected to the Internet today, if he has the curiosity and an Internet connection, is as [empowered] as me. But if he does not get the right nutrition, he will never play that game. Yes, the world is smaller, but do we really see the conditions that people live in? Isn't the world still really big enough that we don't see the real conditions that people live in, the kid whose life can be saved for $80?”
Let's stop here for a moment and imagine how beneficial it would be for the world, and for America, if rural China, India, and Africa were to grow into little Americas or European Unions in economic and opportunity terms. But the chances of their getting into such a virtuous cycle is tiny without a real humanitarian push by flat-world businesses, philanthropies, and governments to devote more resources to their problems. The only way out is through new ways of collaboration between the flat and unflat parts of the world.
In 2003, the Gates Foundation launched a project called Grand Challenges in Global Health. What I like about it is the way the Gates Foundation approached solving this problem. They didn't say, “We, the rich Western foundation, will now deliver you the solution,” and then issue instructions and write some checks. They said, “Let's collaborate horizontally on defining both the problem and the solutions-let's create value that way-and then [the foundation] will invest our money in the solutions we both define.” So the Gates Foundation placed ads on the Web and in more conventional channels across both the developed and the developing worlds, asking scientists to respond to one big question: What are the biggest problems that, if science attended to them and solved them, could most dramatically change the fate of the several billion people trapped in the vicious cycle of infant mortality, low life expectancy, and disease? The foundation got about eight thousand pages of ideas from hundreds of scientists from around the world, including Nobel laureates. It then culled through them and distilled them down to a list of fourteen Grand Challenges-challenges where a technological innovation could remove a critical barrier to the solving of an important health problem in the developing world. In the fall of 2003, it announced these fourteen Grand Challenges worldwide. They include the following: How to create effective single-dose vaccines that can be used soon after birth, how to prepare vaccines that do not require refrigeration, how to develop needle-free delivery systems for vaccines, how to better understand which immunological responses provide protective immunity, how to better control insects that transmit agents of disease, how to develop a genetic or chemical strategy to incapacitate a disease-transmitting insect population, how to create a full range of optimal bioavailable nutrients in a single staple plant species, and how to create immunological methods that can cure chronic infections. Within a year, the foundation received sixteen hundred proposals for ways to meet these challenges from scientists in seventy-five countries, and the foundation is now in the process of funding the best proposals with $250 million in cash.
“We're trying to accomplish two things with this program,” explained Rick Klausner, a former head of the National Cancer Institute who now runs the global health programs for the Gates Foundation. “The first is [to make] a moral appeal to the scientific imagination, [pointing out] that there are great problems to be solved that we, the scientific community, have ignored, even though we pride ourselves in how international we are. We have not taken our responsibilities as global problem solvers as seriously as our self-identity as an international community. We wanted the Grand Challenges to say these are the most exciting, sexy, scientific things that anyone in the world could work on right now... The idea was to fire the imagination. The second thing is to actually direct some of the foundation's resources to see if we could do it.”
Given the phenomenal advances in technology in the last twenty years, it is easy to assume that we already have all the tools to address some of these challenges and that the only thing lacking is money. I wish that were the case. But it is not. In the instance of malaria, for example, it isn't just the drugs that are missing. As anyone who has visited Africa or rural India knows, the health-care systems in these areas are often broken or functioning at a very low level. So the Gates Foundation is trying to stimulate the development of drugs and delivery systems that presume a broken health-care system and therefore can be safely self-administered by ordinary people in the field. That may be the grandest challenge of all: to use the tools of the flat world to design tools that work in an unflat world. “The most important health-care system in the world is a mother,” said Klausner. “How do you get things in her hands that she understands and can afford and can use?”
The tragedy of all these people is really a dual tragedy, added Klausner. There is the individual tragedy of facing a death sentence from disease or a life sentence of broken families and limited expectations. And there is the tragedy for the world because of the incredible lost contribution that all these people still outside the flat world could be making. In a flat world, where we are connecting all the knowledge pools together, imagine what knowledge those people could bring to science or education. In a flat world, where innovation can come from anywhere, we are letting a huge pool of potential contributors and collaborators slip under the waves. There is no question that poverty causes ill health, but ill health also traps people in poverty, which in turn weakens them and keeps them from grasping the first rung of the ladder to middle-class hope. Until and unless we can meet some of these grand challenges, much of that 50 percent of the world that is still not flat will stay that way-no matter how flat the other 50 percent gets.
Too Dlsempowered
There's not just the flat world and the unflat world. Many people live in the twilight zone between the two.
