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By decreasing the amount of wealth that is necessary for a human person to remain alive - for example by introducing a new vaccine that allows a large (5+) family in unsanitary conditions to have all of their children reach adulthood - these sorts of programs in undeveloped countries actually create more poverty then they solve. There is not a cheap-manual labor shortage in these countries. There is however an acute shortage of well-paying jobs that don't involve corruption. By allowing the supply of just-surviving people to increase, you are putting even more downward pressure on the wages of unskilled labor (they are caught in the Iron Law of wages).

I refuse to believe that the loss of life is perferable than the preservation of life. And quite frankly, arguments from classical economics seem rather cold given the subject matter.

The heart of your argument suggests that the political issues in these countries are the root of the problem. This is correct. However, history shows us that the amount of money spent on politically bankrupt states has little or no impact on making them politically sound. Gates money is useless on the third world political playing field; instead, Gates is choosing to spend it in an area which he can actually have an impact.

As far as domestic politics go, the positions you suggest that Gates take on "farm subsidies, fossil fuel subsidies, and the recreational diamond market" are all politically untenable at the moment. It's not clear Gates could have an impact there either.

"political issues in these countries are the root of the problem"

well, it's political-economical-cultural, you can't really isolate one like that.

I'm not advocating Gates giving money to those governments, so they chose what to spend on. I agree that would be even worst - they would buy guns to strengthen their armies and luxury goods for themselves on their visits to Europe and Dubai.

10B can have quite a large impact on political realities in the US. Electing Obama cost a lot less then that.

Are you arguing that the Gates Foundation can create the greatest amount of good in the world through lobbying and political spending in the U.S.? I think the Gates Foundation has it right: e.g. rather than relying on lobbying for educational reform, it is trying to innovate new methods of teaching and teacher-feedback which - if successful - will improve the education system with new methodologies rather than political ideas.

"I refuse to believe that the loss of life is perferable than the preservation of life. And quite frankly, arguments from classical economics seem rather cold given the subject matter."

I don't think he said that. What he said is that improving the economy might help more people than just handing out vaccines. By improving the economy, people get vaccines anyway (they can buy them themselves).

This sort of spending tugs at the heart strings but unfortunately it can actually be quite counter-productive at improving the lives of people in undeveloped regions.

I could not disagree more strongly regarding vaccinations not being an effective economic development tool.

Take the polio vaccination program for instance. Polio. Polio doesn't often kill people, but it does often make them lame for the rest of their lives. So, for every person that gets polio, they are extremely limited in the economic goods that they can produce, but they are also an economic drag on the family, because they are a financial burden rather than producing income. Polio has been almost eradicated, and the economic benefits to poverty stricken countries has been huge.

Small Pox is another example. It has all been eradicated, life expectancies have gone up in the third world because of it, and more people are able to produce income for longer.

Other diseases like Malaria, Cholera, Dengue affect hundreds of millions of people world wide each year, and they aren't necessarily killer diseases. And, millions and millions of people are affected by these diseased, and when they are infected, they are an economic drain.

Preventing these diseases with a simple vaccine is going to give a much greater economic boost to poor countries than giving them clean energy technologies or superhighways.

Keep in mind that in these countries, with no real legal system, unskilled labor doesn't mean gardening like it does in California but violence in the form of gangs/thug-ocracies who typically control access to natural resources or drug running routes

That, sir borders on the racist. What countries are you referring to? There are well over a hundred developing countries with various levels of legal systems and economies. Are you saying that all developing nations are thugocracies? Are you suggesting that any and all unskilled labor in developing nations ends up leading to gangs?

I'm not saying we don't need $3 or $30 or $300 life saving treatments. If the treatment is worth it - if a living person generates enough wealth to cover the treatment - then of course it's good for the economy. The fact that the polio vaccine was worth the investment is why people in America chose to put money into it. But an outside force artificially lowering the cost of the treatment to basically zero means that you are keeping people alive that are not able to generate any wealth at all. In fact, in a place with too many people and not enough ways for them to generate wealth (land or jobs), you are perpetuating conditions that breed violence and corruption, leading to negative wealth creation through your actions.

I'm not saying we shouldn't try to help, if possible - but we need to attack the right problem. The reason we don't is that because there is a real cost to us to do so. People who are all for money towards cheap vaccines want to help as long as it doesn't cost them anything other then their admiration.

"Preventing these diseases with a simple vaccine is going to give a much greater economic boost to poor countries than giving them clean energy technologies or superhighways."

If America continues polluting the world to the point where temperatures rise above 2C and global climate patterns are disrupted, we will have directly caused the deaths and suffering of tens or hundreds of millions of people. Not causing those deaths is indeed a greater economic boost then cheaper vaccines. We need clean energy everywhere, starting with the US and China.

Infrastructure that supports trade is an excellent investment. Superhighways? That makes it sound like you've never left the suburbs, man. These places need a road connecting their capital to everywhere else that can handle 2 lanes of traffic each way, and a port that can handle a decent size ship. No, they don't already have that.

"That, sir borders on the racist. What countries are you referring to?"

Who said anything about races? I'm referring to any country where managing natural resources is a substantially larger portion of the economy then leveraging human capital. In that case, ruling elites have huge financial incentives to actively deter development of human capital. That would be a challenge to their rule. Their government might have "democracy" and laws that sound great, but at the end of the day the job of the police and military is to keep the powerful in power, and in that sense they are nothing more then a glorified gang.

I would believe Bill Gate's sincerity if he permanently moved to a developing country and tried building a profitable business (any business!) there. If you want people to live a wealthy lifestyle, they need a way to generate that wealth themselves.

By decreasing the amount of wealth that is necessary for a human person to remain alive - for example by introducing a new vaccine that allows a large (5+) family in unsanitary conditions to have all of their children reach adulthood - these sorts of programs in undeveloped countries actually create more poverty then they solve.

Stated more simply: It is good that children in poor countries are dying because if they had lived then they would have created more poverty.

How is this getting any upvotes? marciovm, Gates isn't spending this money to play up his image to the American public and to tug at America's heart strings. He's doing this because it's right. Giving people vaccines to live is right. Letting them die because it might create less poverty isn't - it's missing the point that all lives are important.

I completely agree that empowering the economies of developing nations is a very high priority. Higher GDP's lead to longer life, lower infant mortality, more education, less children per mother (because the opportunity cost of having a child is higher once the mother gets a high salary), etc. However, researching vaccines is just as important and necessary for developing countries that are crippled by HIV/AIDS, malaria and tuberculosis.

I agree. Bill is saving tens of millions lives. I am disappointed that Marciovm'sfirst reaction is to judge Bill's great effort and criticize him as a person who just want to get good names. This certainly isn't true. Even if it is true, it is not important/relevant because he is still saving millions.

Ok, I guess I deserve ad hominem if I hinted at it.

I grew up in Brazil and that makes you more cynical then growing up in California. When you live in a place like that, you learn that just because something sounds good doesn't mean it is.

I'm also a graduate student at MIT working on cancer nanotechnology. When not being provocative online I spent all my hours in lab developing tools for oncologists to detect cancer earlier and treat it better. I have a patent from my undergrad research at Berkeley for a needle-free drug delivery device that is moving through animal trials to hopefully make injections less painful for people (even kids - think of the kids!).

I also spent a ton of time making the MIT Clean Energy Prize into a national organization, to help students across the US get access to capital and mentorship so they can start clean energy companies when they graduate.

Is that altruistic enough for you?

While I am quite cynical about many situations in the world, I absolutely reject cynicism here: preventing the deaths of children is good. I don't care how poor their country is, or how likely they are to grow up into poverty. They still have a chance, even if a small chance, to grow up and make something of themselves. No child should ever be left to die because statistics say they will have something we judge to be a "bad" life.

Yes, Great work. I guess i just misunderstood what you said in the earlier post.

Chill out -- marciovm is a great guy. Regardless of which side you're on, it's a healthy debate to have.

>I would much rather have Gates spend his money on clean energy research or infrastructure projects.

You have to look at the margins. Is the benefit of $10 billion spent on vaccine research greater than $10 billion spent on clean energy or infrastructure? I think it is.

There are already many companies, subsidies, and grants for clean energy. Honda has revenues of about $120 billion per year and it spends 5% of that on R&D. Of course not all of that is spent on clean energy, but Honda is only one car company. $10 billion is a small fraction of the amount spent per year on clean energy research. For comparison, the WHO's yearly budget is around $1 billion.

What about infrastructure? The new bay bridge has a price tag of $6 billion. If that's anything close to the typical price of building big stuff, then vaccine research is definitely more cost-effective in terms of lives saved.

> these sorts of programs in undeveloped countries actually create more poverty then they solve.

Yes, it's a trade-off. More poor people for fewer dead people.

Living in Somalia sucks, but living in a Somalia with smallpox would be even worse. We know the problems of many 3rd world countries are more than just matters of supplying basic needs. You point out the harm caused by corruption and crime, but you neglect another reason for the lack of progress: disease. Workers can't work if they're stricken with malaria, or crippled from polio, or dead from smallpox.

It's true that many cannot afford to pay for vaccines. Luckily, philanthropists and governments like to give money to groups like the Pan American Health Organization (which eradicated smallpox and polio in the americas). If everyone had to pay for their vaccines, smallpox and polio would still kill millions.

Smallpox killed 400 million human beings in the 20th century. That's more than every war since 1900. Now it is gone. Polio crippled hundreds of millions. It remains in only four countries. There are hundreds of millions of cases of malaria each year. Several million die from it, mostly children. It is the biggest killer without a vaccine, and it's about fucking time that changed.

Two things:

1) Are there any studies that support the "making people healthier would be a net loss to many societies" claim I keep seeing? It's one of those things that sounds like it makes sense, but no one really quotes any credible sources.

2) I would be utterly shocked if he did this to make himself popular in the US. You may put your own money elsewhere, but he's really a pretty smart dude who seems to do a great deal of research before making decisions. It's a little childish to write it off like that.

1) Those studies are very hard to do, because you can't set up control conditions. "A Farewell to Alms" by Clark has historical data which might be the closest thing to. For example, per capita income in Europe went way up after the Plague.

2) I don't think he is being uber-sneaky about this - I believe he has mostly intentions. But good intentions don't guarantee positive (or optimal) results.

I also think Gates wants to be respected by society, and before he started giving billions away his street-rep was of a geeky, conniving person. Now he is a Times person of the year and everyone loves him. You don't think he thought about that?

Clean energy is important and the US government is already spending tons of money on clean energy research. We need people like Bill who will put his money on those who are more unfortunate just because they are born in a wrong place at the wrong time. He is addressing a very important problem. Drug companies don't usually develop drugs for diseases prevalent in developing countries. This problem needs to be solved. You talking about improving economies is too ideal and vague. On come on, give Bill a break. Can't we just simply applaud Bill's great effort to save millions of lives? I am disappointed that people's first reaction is not praise but criticisms (though maybe constructive). Let's just praise this man for his great endeavor for a minute first, ok?

So we should let people die because it's better in this calculation? Out of all the ways of solving such problems isn't letting people die one of the least desirable?

That is such a paternalistic thought. Their lives are their own, they are not ours to protect or to give up on. If we want to help those societies, the best thing we can do is to help their economies, which indirectly is the best possible way to avoid more people dying unnecessarily in the future.

It is NOT paternalistic. So if you come across someone on the road and he is bleeding and dying. Will you help that person? Or will you think that he is bleeding and dying because there is violence is this society. So we should stop violence first so that no one will get hurt and die. For this poor person you come across, just let him die till he runs out of blood. It's just not right.

What happened here is that person lost their job because we (the US) can way out-compete them with our superior technology and global military might. Then they tried to go steal some food because they didn't have any money, and lost the fight, and now they are dying from their wounds. You think the right thing to do at this point is help this person, and that if we do so, we should feel good about it. I think a bigger priority is not causing another 10 people tomorrow from having to go through the same problem.

If anything, your statement is more paternalistic, father knows best

Bootstrapping out of corruption, low faith in the state and minimal social infrastructure is a really hard problem. Public health, education, workforce capacity, the rule of law, and economic productivity are not separate problems that can be addressed in isolation. The problems are interdependent and really, really hard to solve. Pretending otherwise does a disservice to the people doing something to help.

You might be unaware of how much his foundation has given towards micro-lending and education in poor countries. This vaccine initiative just happens to be the largest of its kind ever.

Also, it should be noted that the foundation (according to Wikipedia) specifically targets problems "ignored by governments and other organizations".

You're right - such massive population interventions (for the better) have little precedent, so there may be some consequences that we're unaware of.

But I think you can improve lifestyle in two ways -- increase income like you mentioned, or decrease costs. It's possible for technology to bring costs down. And when costs come down, a $100 income can buy the lifestyle that $300 used to. So even if you depress wages, you can still win by depressing costs even further through technology.

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"The vast majority of workers in poor countries are agriculture workers"

I think that's not true, and population trends are strongly against it, largely because of improved sanitation.

For example, Nigeria is the most populous country in Africa, urban population is about 50%. I'd bet their urban population is growing like crazy while the rural is shrinking.

"Job opportunities are important, but lowering mortality rates helps this."

Not always. That's a big assumption. Are there massive job opportunities around that require cheap labor? There are in China. They are getting to be rich by manufacturing. Not because Americans came in and solved all their health problems. Because Americans opened their markets and there was a government in place that enable the country to take advantage of that (a dictatorship with a bunch of problems, no doubt, but you can't say they haven't fueled economic growth).

"People dying young is inefficient, since it makes education and training more expensive"

Unskilled labor is by definition not educated or trained.

"eliminating Smallpox has made the world a worse place"

Well, it's highly subjective to say what makes a place better or worse. What are we trying to maximize? Human-life-years lived? Or human-life-years-lived without living under dictatorships, constant war and corruption?

Sure, research in medicine always has value. But making existing vaccines 10x cheaper the best alternative right now for our society to spend it's excess wealth in? Why does any of this matter if sea levels go up a few feet, and tens/hundreds of millions are forced to flee over national borders (and that leads to massive conflict)?

It's a question of maximizing short term vs. long term good. If you took combine 10 billion with a little leverage you could build ~(20 GW) worth of electric power in a self sustaining fashion that would pay for its replacement when the time came. If you setup the right foundation that focused on growth you could probably replace all of the worlds coal power plants in ~150 years. Or you can spending that money now, and vaccinate a large number of people for a low cost per person and dramatically reduce a specific type of suffering for a reasonable amount of time.

To me, developing an infrastructure for energy and developing vaccines are both long term goods.

I don't think it's exactly a long term goal. Biotech is in the middle of a rapid development phase, developing vaccines now is useful in the short term. However, basic research would probably pay a higher ROI in the long term. Few useful things you could do with that money are really short term goals just vaccinating the young falls into the range of somewhat long term, 40 years from now some of those people would be benefiting from that vaccination. So it's really a comparison to midrange vs long term.

This is not to say I think short term goals are bad, just the fact you need to mix them. If I had Bill Gates’ wealth I would build a full scale fusion reactor using an updated and modular version of ITER's design. It might only reduce the time till the first commercial power plant by 10 years but I would still do it

Food, shelter, medicine, education, jobs and energy.

We should be investing in all of them. But as you say, corruption gets in the way of good will.

Thank you, I wholeheartedly agree with you. Perhaps I'd have made it clear the problem is corruption and lack of [education on] birth control [constantly sabotaged by religious groups. (Perhaps you wouldn't agree with the last bit?)]

From a neighbour country, down south, have an upvote :)

Edit: Clarification in square brackets.

"When Melinda and I first started our giving, in the late 1990s, our focus was on reproductive health rather than childhood deaths. We felt that giving mothers the tools to limit their family size to what they wanted would have a catalytic effect by reducing population growth and making it easier to feed, educate, and provide jobs for the children who were born.

We were surprised when we saw a newspaper article in 1998 showing that only a few diseases cause most childhood deaths and showing how little money was being invested in creating and providing vaccines for these diseases. A chart in the article showed that a particular type of diarrheal disease—rotavirus—was killing over 400,000 children per year. How could a disease we had never heard of get so little attention and kill this many children? We sent the article to my father and asked him to look into how we could help. A surprising but critical fact we learned was that reducing the number of deaths actually reduces population growth. Contrary to the Malthusian view that population will grow to the limit of however many kids can be fed, in fact parents choose to have enough kids to give them a high chance that several will survive to support them as they grow old. As the number of kids who survive to adulthood goes up, parents can achieve this goal without having as many children."

2009 Annual Letter from Bill Gates: Childhood Deaths: http://www.gatesfoundation.org/annual-letter/2009/Pages/2009...