Bill & Melinda Gates Foundation: A life is being saved for every $1000

In this freewheeling conversation, Hassan Al-Damluji, the Head of Middle East Relations at the Bill & Melinda Gates Foundation, highlights his organization’s activities in the region and touches upon humanitarian challenges across the globe. He also sheds light on the status of Millennium Development Goals and the Foundation’s 24 different programs.

Al Arabiya English: How would you sum up the activities of the Bill and Melinda Gates Foundation in the Middle East region in recent years?

Al-Damluji: Overall the Arab world, and even more broadly the Muslim world as a region, is a huge area of the planet and population containing almost exclusively developing countries. Some of them are suffering from challenges that the Gates Foundation focuses on. These countries are battling against diseases such as malaria, HIV, and polio. There is low agricultural productivity, which may be affected by climate change and so on. These are the challenges we work on.

But many Arab and Muslim countries are emerging economies and are increasingly major donors. They have sophisticated research centers and qualified people who are the solutions to these problems. So when we look at this region more broadly, we think about, how we can play a more catalytic role to enable local solutions. I think countries in the GCC are increasingly interested in making sure that they are playing as positive and impactful roles across that broader region. As they have succeeded in developing their own countries they’re looking beyond.

Al Arabiya English: The region as you said is not homogeneous. There are varying populations and so is resource distribution. Do you approach it from a regional perspective or country-by-country to find solutions to their challenges?

Al-Damluji: We very much look at it from a regional perspective. The Gates Foundation from a starting point, always wants to operate in a global level because we start from the principle that all lives have equal value. If you do work in that principle and you identify a problem that is the people who don’t have opportunity in this world you’ll probably find that problem is global. So it could be a disease or just lack of good seeds.

So our malaria program is global but when you look at it in greater detail, you find that the solutions may vary and so are the partnerships you need to solve it. We would always like those partnerships to be as broad as possible. That’s why we like to stick to the regional perspective. I mean, the issue of Syria is interconnected in other countries. The farmers in Egypt are suffering from the same climate change stress that they’re suffering in Algeria.

Al Arabiya English: So there are commonalities but the solution has to be tailor-made depending on the requirement of those countries?

Al-Damluji: Yes, and we are funders only, so we are always going to be working with partners who are actually implementing the solution on the ground. Wherever possible, you want to find scale. And so, rather than finding a different partner for every village, or even for every country, wherever possible, it’s better to create a system. The example is an initiative like GAVI. It is a vaccine alliance that globally procures all the vaccines that poor countries need, therefore having the scale to really drive down costs, making sure there’s coverage.

Then with a single organization, you can make sure that every country has access to those vaccines. That’s a more efficient way of doing it rather than trying to create a different vaccine fund for every country. So, that’s where a lot of our funding goes at a global level. Now if you come down to this region, that’s why we pick partners like the Islamic Development Bank for example, which operates across the whole Muslim world. Because in that single partner, you have historical currents, ties of culture, religion and at an administrative level office in all those countries. So you have access to those areas that is unique and specific, but you’re still covering 56 countries with one partnership. Individual donor countries like Saudi Arabia, like the UAE, are also examples of that. A single partner like the UAE has relationships across the board.

Al Arabiya English: How do you synergize your expertise with the requirements on the ground?

Al-Damluji: So what we can bring is that we put our money in, but we also have a lot of expertise. For example, in polio, as a disease we know the different DNA strains of the different types of polio. We know how to monitor sewage to understand, even if there are no cases, the disease still exists in a particular region, so that’s what we bring. Then other partners bring their relationships and geographical knowledge. For example, the UAE hosted a vaccine summit, where the whole world came to the UAE to contribute a total of $4 billion for polio.

They’ve also managed to carry out their own campaigns in the most security challenged areas of Pakistan, to eradicate polio. Again, something our staff can’t do, whereas the UAE has those relationships and can send a message that they, as a Muslim country, want to eradicate polio, because they know this is the right thing to do, that makes Pakistanis if there are doubts to whether the vaccine is a myth or a conspiracy, it helps to have the UAE giving that message.

Al Arabiya English: Is resistance to vaccination a Pakistan-specific problem? Have you faced it in other parts of the world?

Al-Damluji: It’s not just Pakistan. The fact is that when there are billions of dollars going into eradicating a disease, there’s got to be a reason as to why these children are still not vaccinated. Its more than one reason. Now the challenges are across the board, it’s not just resistance to vaccination, and I wouldn’t describe it as a cultural challenge, I would say there’s a specific, political, security, issue that the polio campaign unfortunately, as other things, got wrapped into. And so there was a point as which the Taliban where preventing vaccinators from going in, there were vaccinators being targeted, and this is part of, not all of, the reason why it became very difficult to eradicate the disease.

However, I’m glad we’re making incredible progress right now. In 2015, there were just 74 cases of wild polio globally, the year before they were 359 cases, and back in 1988 there were around 350,000 cases. So that’s a radical improvement. But to answer your question, similar political challenges were happening in northern Nigeria, which is why northern Nigeria was one of the last places in the world to have polio, although now we’ve gone over a year without having any cases, which is great news. In Nigeria there was also an insurgency, there are security issues, these issues of health get wrapped into it.

Al Arabiya English: How would you rate the progress of global social uplift programs such as Millennium Development Goals? Are its targets being achieved?

Al-Damluji: The Millennium Development Goals were a great thing, and the world made a lot of progress. Everything we do contributes to some part or other of that overall agenda. The Gates Foundation has about 24 different programs. Many of them are individual diseases, malaria, HIV, others are issues like sanitation or agricultural development. Each program will have a set of impact targets which we are trying to hit in terms of the real impact, for example, fewer cases of the disease, or even more materially, lives saved or the improvement in lives.

So let me give you an example of hitting tangible targets. GAVI, the vaccine alliance has been going for 10 years now. It takes time, but the data starts coming out to tell you how you’re doing. We can say with some confidence that between six and seven million lives have been saved from our investment and the investments of others who have joined us. So we’re talking about one life being saved for roughly every thousand dollars. Now this is a very good value of investment. Now it’s not easy to compare one investment to the other but we always try, so that we know we’re focusing on the right things.

Now the world has adopted new goals, as the Millennium Development Goals have expired. The new ones have been called the Sustainable Development Goals (SDGs), which are broader than what we do. We focus on absolute poverty. SDGs have seen an effort which is commendable to get every country in the world to sign up to goals, so by definition, some of it will be more appropriate for the wealthier countries. We work a lot with the U.N. We fund the World Health Organization, UNICEF, and others.

Al Arabiya English: Do you imagine a world when an NGO such as yours will become irrelevant because the challenges will cease to exist?

Al-Damluji: Well we do and we plan for it, because the Foundation’s charter or articles of association contain within them the clause that every dollar has to be spent within 20 years of the last trustee dying. Now there are only three trustees, Bill Gates, Melinda Gates and Warren Buffett. Warren Buffett’s gift which is 85 percent of his shares, therefore his wealth, which is huge amount of money. That has to be spent within five years of his death. So we’re actually we’re looking at, within the coming decades, spending all of the money.

So a different set of philanthropists will focus on the challenges 100 years from now. Hopefully, many of the challenges we work on will be gone and therefore they’ll be focusing on different ones. Or they may decide that some of them they should stay with. But our founders thought: let’s not us dictate how in a hundred years they should spend their money, let’s focus on these challenges and put all of our resources into getting them fixed. We are confident that extreme poverty will be eradicated, malaria will be eradicated, and there is no question in our minds that polio will be eradicated very soon.

The extreme poverty and malaria we’re talking a 15-20 year timeline rather than a 3 year time line. But there will still be a need for philanthropy and aid. If humanity cannot see any challenges worth investigating it’s because we’ve lost imagination, not because we’ve solved all the problems.

Al Arabiya English: What next is on your agenda as far as this region is concerned?

Al-Damluji: Conceptually what we’re about is helping local actors fix problems in the Middle East, Arab world, and across the Muslim world. What we’re doing to build on is building a big fund, called the Lives and Livelihood Fund with the Islamic Development Bank. The idea is to leverage our money as times are tight and there are always good reasons to be efficient in how we use money. So with every grant dollar, four dollars of loan money is released. If you get five dollars for every dollar but that loan money is being borrowed by a developing country, which means that they have to pay something back. This means they’re on the hook for their own development too which is also powerful from a governance mechanism.