 Thank you all, and thank you Dr. Tachi Yamada for joining us here today for a conversation on the value of long-term investments in global health, the importance of measurable progress and the Foundation's priorities in 2011 and beyond. Our audience all have Tachi's bio, and he's familiar to many of us. He's president of the Bill and Melinda Gates Foundation's Global Health Program has been in that role for five years and leads the Foundation's efforts to develop and deliver low-cost, life-saving health tools for the developing world. Tachi, I'd like to just ask you to open things up with a few minutes of remarks, and then we can come back for a conversation. Thank you very much for being with us. Thank you for having me here, and thanks to CSIS for holding this symposium. I think back on my five years at the Foundation and really tried to look back and said, where was it that we put our emphasis and why did we do it? And I think these are very important lessons, many of the themes you've already heard today. The first of our efforts was to create a sense of urgency. Now, you would think that with 8 million children dying each year today that there would be a sense of urgency about this. But we've gone through an evolution in time that might explain why that urgency was more difficult. We used to have enough money to do pilot projects somewhere. We would do a demonstration project and say, well, under these controlled circumstances and with these kind of resources, we can affect this kind of change. Then we'd pack up our bags and go home. And we wouldn't worry about actually doing anything about the data that we got because there wasn't enough money to do anything about it. But what's happened in the past decade is that there's been a quadrupling of the amount of money to do something about it. Today there are some 25, 26, 27 billion dollars each year for global health. That's a lot of money. That's a lot of money considering that many countries spend $10 or $15 a year on health. So now we can actually make a difference. The Global Alliance for Vaccines and Immunizations during its 10-year lifespan estimates that it's prevented 5 million children from dying. Under those circumstances, a sense of urgency is important because not only do we know what to do, but we've got the money to do it. And so time is our enemy. We have to apply that money effectively to create the changes that we know we can make. And that leads to some very audacious goals. You know, we're trying to eradicate polio. A few years ago, people thought that might be impossible. Actually, in 2007, Bill and Melinda Gates put out a call for eradication of malaria, another audacious goal. But we have the resources. We think we know what needs to be done, so we have to have urgency to get there. The second very important initiative I think we had was initiative on innovation. Innovation is a word that people often use, but it may not mean a lot to a lot of people because I don't think there's a corporate logo that doesn't have on it somewhere. Innovation is our core culture. But innovation really has to transform the way we think about something. Innovation can be revolutionary. It can be evolutionary. But the revolutionary kind is what really changes how the world thinks about a problem. So we've invested in innovation in science. We have a program called Grand Challenges Explorations. We're looking for wild and crazy ideas, and we fund many of them with the hope that just a few of them will prove to be ground changing, transformative in health care. And we think we're on to some very important discoveries as a result. But this innovation doesn't have to be restricted to science. We believe in innovation in financing. Very important. There's not that much money to go around. How do we spread that? How do we create more funding? We've really focused on many different vehicles, advanced market commitment, a way to bring the pharmaceutical industry into the production of vaccines so that they could achieve a reasonable return on their investment or the affordable medicines facility for malaria, a mechanism whereby funding could trickle down to the retailer in the private sector so that the right malaria medicines would be given. Or recently, we've started using the Gates Foundation's balance sheet to guarantee volumes and purchases for vaccines to get the pharmaceutical industry to lower their prices because their prices, of course, are very dependent on volumes. And without certainty on the volumes, it's very difficult to guarantee a low price. Another area of innovation is in the delivery of what we do. The implementation of the tools we have. A very good example of this is the program that we had on HIV control in India. There, there was a problem, and the solution for this problem was that the major epidemic was in a female sex workers and men who have sex with men. The biggest problem was not that there wasn't knowledge about how to prevent transmission of HIV, but people weren't empowered to actually act on the knowledge that they had. So the whole effort in HIV control in India was focused on empowerment of, of communities of people who were at great risk. The third area we've talked about already, and that's the area of monitoring, measuring, learning, and evaluating, and changing course. It's easy to say that, but the most important element of this is actually having the data itself, capturing the data. So we have focused a lot on trying to obtain the data and then evaluating it in the most dispassionate way possible. We've invested in the health metrics network, the international initiative for impact evaluation, the in-depth network, and the Institute for Health Metrics and Evaluation. I used to work for a CEO of a pharmaceutical company who's a professional tennis player, and he used to say that if you're not keeping score, you're just practicing. And in fact, if we aren't monitoring, if we aren't measuring what we're doing, we are just practicing, and we can't practice for a condition that leads to death and misery. And then finally, and most importantly, I think the initiative that we focused a lot on was partnership. There's no way to get everything done in global health if we act as independent actors. And people keep talking about this concept of the global health architecture, that the global health architecture needs to be fixed. Well, it will never be fixed because there are many players. What it requires to work is a willingness to partner, collaborate, to communicate, to coordinate. And I think in the past five years, there's been a huge increase in that kind of activity. Just to give you an example, there's an organization called the H8. Well, it's amazing until three or four years ago. The heads of the large groups that had a major impact on global health, like UN AIDS and UNFPA and WHO and the Global Fund and the Global Answer Vaccines Immunizations and so forth, never meant to talk about the programs or what were the key things that were going on in their shops. Now they meet on a regular basis, and in between there's tremendous interaction. More recently in the Global Answer Vaccines Immunization, there's been a tremendous effort to bring the key stakeholders together, the key funders together, to decide what it was that we wanted collectively out of this initiative, and that has had a huge impact on how that organization works and runs. Imagine a world where there would be a war between the WHO and UNICEF and the U.S. government, USAID, and DFID over what gets done where. That would be the most wasteful, most non-productive and most damaging development that could possibly occur, and I think in the five years that I've been associated with the Gates Foundation, that's never happened, and I think all trends are that whatever differences there may have been, they'll continue to disappear over time. So the idea of working with a sense of urgency, of seeking innovative solutions, of constantly measuring what we're doing and changing course as necessary, and of being committed to partnering, working together, this is what I think will create sustainability in our efforts in global health. Thank you very much, Dr. Thatcher, that's very eloquent. As we look back over the last decade, the foundations emerged as such a prominent force, an independent force in our society and beyond our own borders, really. As you look back over the last five years of your leadership position, what do you think has really been, and as your voice and as your catalytic, your ambitions to act in this catalytic way along these five or six areas that you've just described, what's been the toughest revelation for you, do you think, in moving that agenda forward? I think the most difficult challenge for us is that most everything that we've done in global health up until now, we, meaning the global health community, has been focused on the public sector, and yet, when you think about a place like India, where 75% of all healthcare is paid for out of pocket in the private sector, we're really playing in the proverbial street lamp, looking for the keys under the proverbial street lamp, when there's a whole host of other problems that relate to the private sector that we haven't addressed, and I think that's going to be the big challenge for us going forward. One of the aspects of the Affordable Medicine Facility for Malaria that I liked, the so-called AMFM, is that it was focused on where people get their malaria medicines, and that is in the private sector, and to try to change the retailer's behavior in that private sector to ensure that the right medicines get delivered, we're going to have to do much more of that in the future if in fact we want to move the needle in public health. We just talk about tuberculosis. Most of you know what tuberculosis is, but it starts out with a little bit of fever and a cough. Where do you go for that? Do you go to the hospital, wait in line for an hour, two hours, three hours, and maybe get seen by possibly a nurse? No. What you do is you wait and see the chemical seller who comes into your village and you get whatever medicine they have for a cold. Three months later, after you spread it to all your neighbors, you know, you're feeling worse, you see the chemical seller again, it gives you something else. Well, six months later, you finally go to the, you're bad, you're badly off enough that you go to the health clinic and you get seen. If we don't solve this problem of private medicine, of the private sector way that people seek health care, we'll never solve the problem of TB in many countries because we have to diagnose this problem before people can spread it. Thank you. I know in your role at the foundation, your own business background, the role you've played with the Pacific Health Summit now, the Pacific London Health Summit, you've been very active at trying to get a bridging dialogue going between business and the other constituencies and interests in global health donors, implementers, advocates. And we've seen today, we've heard today that there has been a pretty dramatic change, I think, conceptually and rhetorically here in Washington. People are now talking about economic growth, they're talking about private sector engagement, they're talking about partnerships. That is being more fully embraced. It's a different dialogue with business as possible, but translating that into the practicalities of action is a really tough piece right now, it seems to me. It's one of the things fully upon us right now. Can you just comment on that? Well, actually, one of the great advantages of working in a foundation like ours is that it's very easy for us to freely float between the private public sectors. And we fully engage the private sector when it comes to the production of medicines and vaccines and diagnostics. You know, the public sector doesn't make vaccines generally, maybe with the exception of a few companies in Brazil and Indonesia. It's private companies that make vaccines and drugs. So you really have to engage them. Now, they may be relatively lower profit manufacturers or high profit manufacturers, but they're still private entities that are for profit. We believe that we can't succeed without engaging these. And generally, we have a very good dialogue with these companies. Every year we have a roundtable with the CEOs of the top 12 pharmaceutical companies. They come. They're committed. They really want to work and help on our things. This is very different from ten years ago, actually more like eleven years ago, I was working in a company that was part of a lawsuit that was suing Nelson Mandela over the price of HIV medicines. And it destroyed the reputation of the pharmaceutical industry. And it certainly transformed my life in the sense that I was committed to not have that be the legacy of the pharmaceutical industry or my own career. And the industry has since then moved a long ways believing that they cannot succeed in the world today without addressing the health needs of the larger population in the world and committing to providing medicines at an affordable cost, medicines or vaccines at an affordable cost to the vast majority of people. So that relationship and partnership is critically important. I will say that I wish this partnership could extend beyond the pharmaceutical industry because right now the pharmaceutical industry is a very, very committed and strong partner. But it probably costs more to buy gas in some of these countries than it does in the U.S. or God forbid buy a computer or do things that we take for granted every day. Just in thinking about surgery, having surgery requires a surgeon. That's tough enough. But when the tools are used for the surgery, the medical devices that you use cost as much if not more in Tanzania as it does in Minneapolis. Well, you know, we have a problem. And so I do wish we could engage a larger community of American businesses in the challenges in the developing world. Thank you. We're getting to the end of our time now. I want to ask you just one to look ahead a bit and think about, you know, in the next several years how would you expect the foundation's voices and voice and interest will evolve in this fluid situation? How would you see that? I firmly believe that our voice is only relevant if we're partnering with everybody. So the idea that we have a completely independent voice and that we're going to have an agenda that's separate from the agendas of the key stakeholders in global health is probably not realistic. We certainly do have a sense of urgency. We certainly do believe in accountability. We operate by business principles. So if we make an investment, we want to make sure that investment pays off. If it doesn't, we're going to take stock and invest that money elsewhere. But at the same time, we do nothing without partnering with others, the key partners, the key partners of the Global Health Initiative, key partners in the UK through DFID and Norway and WHO, UNICEF and the like. And I view us as being the hopefully not only good partners but also thought partners in the leadership of key issues in global health. Thank you very much. Thank you.