 Thank you all for coming. We're delighted to have you here. My name is John Hamery. I'm the president at CSIS. When we have public events, we always start with a little safety presentation briefing. I'm your responsible safety officer. I'm responsible to make sure everybody here is going to be safe and well. So if we have an emergency, I would ask you to follow my directions. We have emergency exits behind me, three of them. The stairway is right in that corner. We'll go downstairs. We have mutual assistance agreements with the National Geographic and with St. Matthews Cathedral. St. Matthews is in that way. National Geographic is behind me. Please go to one of those two places. We'll have staff there that'll help. Nothing's going to happen, but I want you to be prepared. And please follow me, okay? We're really delighted to have you here. You know, everything in the world that exists, everything in the world that exists, whether it's a podium, a microphone, a glass, a chair, everything initially started off as an idea in one person's mind. It's really the truth. Now, most people have interesting but small ideas. Melinda Gates and her life partner had a big idea. And that was to find a way to tackle the most pernicious and persistent problem that faces humanity and which is systemic disease. And I think all of us are genuinely richer and better because of their commitment to this cause. We're going to go through that a bit today. I'm very grateful because CSIS has had a 13-year partnership with the Gates Foundation. They are our largest single program. We're a defense think tank, right? Our largest single program is Global Public Health. And it's made possible by the Gates Foundation. And just this last year, they asked us to start working on food security because, as obviously, if people are hungry, they tend to be susceptible to disease. So it's this sort of vision, big ideas that are transforming the world. We're so lucky that we're able to have their leadership with this. We're lucky to have Melinda Gates with us today. Now, it's my role at this stage. I want to introduce Brandlee McHale. The city makes it possible for us to bring this series for all of you. And so I would like to have Brandlee please come up and join me and just say a few words of welcome. Thank you. Good morning, everybody. This is a great room. Look at all these faces, all the energy. Thank you all for joining us today for the Smart Women Smart Power series. Don't you love that title, right? Today's event is the fifth in a series that we began last December that recognizes the amazing talent and indelible impact that women have made across the public, private, and nonprofit sectors. We at Citi believe that partnering with institutions such as CSIS to amplify the dialogue on critical issues and develop a deeper understanding of ways that we can individually and collectively move the needle is a critical building block for progress. We want to thank the entire team at CSIS for continuing to make this series even more powerful and for arranging for Melinda Gates to spark our thinking this morning on an issue that crosses geographic and socioeconomic boundaries. The Bill and Melinda Gates Foundation is a pioneer in helping empower women across the world, but their impact isn't simply related to what they are funding directly. As equally important, by shining a light and challenging the philanthropic world, policymakers, and even private markets to more directly address critical issues, including gender disparities, the Foundation is redefining the way all of us address this issue. And it's important to note I see that they're not just smart women, powerful women in the room today, but men here as well. And this isn't an issue that just affects women. Marginalizing women limits advances for all of society. In fact, the research shows, and I'm sure we'll hear more about this this morning, that putting earnings in women's hands speeds up economic development. Women reinvest a much higher portion of their earnings in families and communities in education and in healthcare, leading to a multiplier effect. So it's not surprising to see that countries with greater gender equality have lower poverty rates. But you don't really want to hear from me. You want to hear from our guests that are on this stage. So let me just wrap up and conclude by thanking all of you for joining us here today and by participating in this conversation. It really is an honor to be surrounded by so many talented professionals. And on behalf of all of us at Citi, please enjoy today's series. And we hope to see you at future events. Thank you. Good morning and welcome to CSIS. I'm Jay Steven Morrison. I'm the senior vice president here at CSIS and I direct our Global Health Policy Center. Two quick points by way of introduction of Melinda Gates, the founder and principal of the Bill and Melinda Gates Foundation and our special guest of honor here today at CSIS. First, as John has emphasized, we've had the remarkable good fortune of a continuous partnership with the Foundation dating back to 2001. And that's enabled us to make global health and the advancement of U.S. strategic leadership on global health a central part of our mission and our identity. It was not a natural choice since we're an international security and foreign policy institution. But we made this choice with the backing to a significant degree because of the faith that the Foundation had in us in carrying that forward and the partnership that developed subsequent to that. It was it was that faith and that partnership that enabled us to enlist Senators John Carey and Bill Frist as co-chairs of the CSIS HIV AIDS Task Force in 2001, where they used their power and that and that platform to lay the legislative groundwork for PEPFAR. And that was a historic moment in global health. It enabled us to hire Janet Fleischman 12 years ago and to enlist her in 2009 to spend months quietly listening to a multitude of politically conservative and liberal personalities, including many faith leaders about their views on family planning. And that the written product that came out of that became a very powerful tool in convincing people that a moderate center exists of sensible, smart people who will stand by U.S. leadership in family planning. The support has enabled us to to create a framework and recommendations for the Obama's second administration on the approaches to women's health that was adopted by President Obama and the presidential memorandum on gender equality and empowering women issued in January 2013 at the advent of the new administration. And it's the support from the Foundation that's allowed us to launch this summer and into the fall, the CSIS Task Force on Women and Family Health, a major high-level commission that will advise the next administration and Congress on these critical issues. We're very proud of these moments and we're very grateful. And thanks to you, Melinda, and everyone at the Foundation for this support. And many of the folks here that work very closely with us, Katie Button, Michael Deisch, Dana Derrida, Tom Walsh. My second point is about the remarkable story of just how Melinda Gates became the prominent global health leader she is today in advancing women's health, women's and girls' health and empowerment, including family panning, nutrition, and other related development issues. In that role, she brings exceptional passion, commitment, expertise, and local knowledge. The puzzling part is how did she possibly get to this point? The path from being a young software engineer at Microsoft in the early 90s to a global leader on health today is not immediately apparent, nor something that childhood friends or parents in church or school in Dallas or classmates or faculty at Duke University would have predicted. What made that remarkable transition possible was Melinda Gates herself, her personality, her ethical center and exceptional intellect, and her determination to consult quietly and carefully with both family and friends as she weighed her choices and no less important her commitment to travel indefatigably throughout the world to listen with countless young women and girls and to engage them in their lives on their terms and in their homes, schools, jobs, and clinics to listen and learn about the realities that they face and what interventions and changes in those contexts are going to bring about lasting and durable improvements. Thereafter, she has translated that vast body of knowledge and insight into a strategic vision that guides her life and guides the life of the foundation. And it's that vision that we'll be hearing much more about today in the conversation that Nina and Melinda will be holding. It's a wondrous personal story. It's inspiring. We all benefit from it, and I'm sure we will hear more. And thank you, Nina Easton, the moderator for Smart Women's Smart Power and Editor in Columnist Forbes for being with us. And thanks to Kathleen Hicks and Beverly Kirk, my colleagues for creating this marvelous initiative, Smart Women's Smart Power, which apparently from the turnout that we're getting today is the smartest and most popular thing we've done in a long time. So thank you very much. Thank you for your patience, Melinda and Nina, and over to you. Thank you so much for those words, Steve. And Melinda, welcome. It is a delight and an honor to be here, to have you here. And as Steve said, I mean, the room, the size of the room shows that, you know, we're going to get into the incredible game changing achievements of yourself and the Gates Foundation and the game changing achievements to come. But first, as, as you know, having been on the Fortune stage, Fortune, we like to do a get the big get to know you. So we're going to do that now. We're going to get to know you a little bit. And I'm talking about you dating back to your youth. You were born and raised in Dallas, Texas. Your dad was an engineer. And what was intriguing to me was that he he had your you and your sister keep books for his company. Tell us about that. Yeah, so my dad was a college graduate. And my mom wasn't and always regretted it actually. And they were determined. So I have three siblings, or four of us in the family, two girls, big gap, two boys. And they were bound to determine that we would go to college. And if you looked around at my household, you could tell that sending four kids to college was not going to be an easy thing. We were very much a middle class family. My dad was an engineer for defense, a space and defense contractor. And the way my parents were going to put the four of us through college was that they ran a small real estate business on the side, they would buy rental properties. And we as a family would fix them up. And then we would rent them out. So I had a lot of weekends where I mowed lawns. And I cleaned ovens with easy off and I painted as did my sister and my brothers. But my dad had another piece besides this dream that we would all go to college, which we all did. And he wanted us to go out of state. He and my mom, because they thought it would broaden us. My dad always believed that teams were better engineering teams if there was a woman on them. And so his teams, when they were working on the early Apollo mission, I knew three of these women, because we would go to the company picnics. And he was always trying to get this one woman who is a mathematician onto his team, because he said, my team is better when she's on it. The teams would rotate around. So I knew that my dad believed in women being good in math and science. And then, as we're working on these rental properties, my dad decided, it's a long story, but my school started to get some Apple II computers. My dad decided, well, if we got an Apple computer at home, it's actually an Apple III, I think about 2,000 of them were ever sold, that his daughters could begin to program and that we could keep the books for his real estate business, my parents real estate business. So I learned Visacalc and I, my sister and I would keep the books for real estate business, but I learned the flows of money then. I learned profit and loss. I could see what months we were barely eking by on the rental properties. I knew what my parents had bought them for and what they'd hope to sell them for later. So I learned a lot about business by keeping those books. And then, at night, I would use the computer on the side to do some programming, which is even my better love. Were there some tough times with the real estate company? Oh, absolutely. There were months where my parents were taking from their personal savings to support the real estate business. If we had, eventually they had 18 properties, and if we had some months where we couldn't rent one out or the market was going down, yeah, it was tough. And I could tell that putting us through college wasn't going to be easy. It's incredibly forward looking of your father back then. My dad was an aerospace engineer as well. I don't think he talked about women and no one did. Women in science and engineering is, of course, we talk about today. Was there any advice that he gave you along the way that has stuck with you? Well, I think it was more that I just knew that both of my parents thought all four of their kids could and should be college going. It was just an expectation. And I think the most powerful things my parents said to me was, you can go anywhere in the country you want to go, and we will figure out how to afford it. Don't worry about that piece of it. We will do it, and we believe you can. And that was just an incredibly powerful thing, even sometimes when I didn't get exactly the same message freshman year in high school from my college guidance counselor who told me I should apply to community college. Is that right? Yeah. So and eventually I knew that just wasn't the right message, but I always had my parents support. And even today I have my parents support. My dad's 76. My mom's about to turn 75. If Bill and I are wrestling with a big foundation issue and we're working through it, I will sometimes call them, actually quite often, call them. And it's more enough that they have the answer, but it's more I can hear myself think about how I'm wrestling with this and where we might go. That's very powerful. How did you choose Duke, by the way? Well it's interesting. So I knew I wanted to study computer science in college. I absolutely knew that. I had an amazing high school teacher who was my math teacher, and she saw that a group of girls of us were getting ahead in math, and she went to the head nun of the school, the principal, and said we have to get computers for the girls. And so she started this little computer programming club, and I was part of that class, and she wasn't afraid to let us get out ahead of her. She was studying computer science at night, getting her PhD, and raising three boys on her own. And it was just incredible. And so I fell in love with computer science in high school and knew I could be good at programming. So I knew I wanted to go into computer programming in college. I was thought I was going to Notre Dame because I went to an Ursuline all Catholic girls school, and a lot of the dads had gone to Notre Dame, so I thought I'll go to Notre Dame. But then when I went and looked, they were phasing their computer program out. They were putting it back in the departments because they kind of thought it was a bit of a fad. And I was really disappointed. And so was my dad, because I'd already gotten in and I had a bit of a scholarship there. So we went and looked at Duke, and Duke had just gotten a big grant from IBM and had these two new computer labs, and really was hiring some great professors, and I said this is where I want to go. They're on the cutting edge of computer science. So this passion for computers, were you a computer nerd? Definitely. I was a math nerd, and then a computer nerd. Yeah, I love logic. You love logic. Okay, and that's what you were just drawn to that and never gave it up. Yeah, computer science to me was like a puzzle. Turns out I love puzzles. I didn't know Bill liked puzzles after we were dating a while, but I like the logic of them, that you have to logic and work your way through. And sometimes you're really uncomfortable when you're trying to solve, at least I was in college, a computer, a hard, hard computer science program. But once you get through it and you find your way through it, you realize, wow, it's good to be uncomfortable sometimes. So how'd you end up at Microsoft? So that's an interesting story. So I was really fortunate in Dallas. I had a summer internship two years in a row with IBM. Had great managers at IBM. And so it was so nice. So I did computer science three years of undergraduate at Duke, and then if you could get accepted to business school early, you could, and I had all my credits done in undergraduate, I could go, I did get accepted to business school early, I could skip my senior year of college, and then I went two years to business school. So I did what was called a 3-2 program, which again my parents love because it saved a year of tuition. And actually I had to go to them and say, on one Christmas break, would you be willing to pay for graduate school? Because they had promised undergraduate, but not graduate school. And so I said, if I do it in five years, and they were like a, you know, they were super supportive. But anyway, so I thought I was going to go work for IBM. And my last year of business school, I had this standing offer from IBM, which was fantastic in Dallas, where my parents lived. And I interviewed a whole host of other companies. They knew I was going to interview, and I turned the other companies down, except for one. And so on my spring break of my last year of business school, I was traveling through Dallas, and I went and actually met with my hiring manager at IBM as a woman. She was just fantastic. And we talked for a long time. I said, look, I've turned everything else down, but I have this one more company to go interview with. And she said, would you mind me asking who? And I said, well, I'm going from here to Seattle, and then I'll come back through on my way back to Duke, but I'm going to interview with Microsoft. And she stopped me dead in my tracks. And she said, do you want my advice? And I said, yeah. And she said, if you get an offer there, take it. Wow. And I said, why? And she said, because at IBM, you absolutely have a fantastic career track. It's a great place to work, work as a man or a woman. But she said, you know, you'll have to go up each ladder of the chain. And she said, my understanding of Microsoft is it's a young company. It's growing really fast. And she said, the chance for advancement for a woman would be really a fast trajectory if you do as well as I think you would do. So does that remain your advice to young women? Look for a mobile company, a company that's where you can... Well, my advice to women is go to a company you're passionate about. Go to whatever subject or company that you're passionate about. But if it happens to be on the cutting edge, like biotechnology today, if you're thinking just biology and you love biology, I'd say awesome. Also look at biotech. Or if you like technology, I would say look at biotech. I mean, if you're on the cutting edge of something, at least to me, that's where it's really fun. That's interesting. Yeah. So you went to Microsoft and you were there for nine years doing what? Nine years. I did move up really quickly in management because I have both this computer science background and I actually really like managing people. And so eventually I worked... I started on Microsoft Word, long before we had Word for Windows, and then long before we had Office, long before we had PowerPoint or any of those things. And then I worked my way up and eventually I was running a big piece of the consumer division, working on a lot of multimedia products. I think I had about 1,800 people working for me, different programming teams and marketing teams and testing. And I worked for Patty Stonesight, who was my last boss at Microsoft. She runs Martha's Table now, and she came and ran the foundation for us for quite some time. That's great. Now your life really took a turn when this guy named Bill Gates asked you out, and you were kind of put off by his excessive advanced planning for the first date I read. Yeah, how did that go? And my mom also took me about four months to tell my mom I was dating him, and she didn't think that was a very good idea. Because, you know, I was new to the company. So I had, so first of all, I never, when I joined Microsoft, they sent me on my first business trip three weeks into the job, and I had never been to New York City. I didn't have a passport. Not that you need a passport to go to New York, but I did need one later to go on my first trip with Bill. But so I went to New York, and anyway, I met Bill briefly at a group dinner that was there, and you know, didn't think much of it. But then, maybe about 12 weeks later, we were back at Microsoft, and you know, pretty much everybody worked on Saturday morning. It was kind of just known. You worked long hours, and you worked Saturdays at least till two or three o'clock. And I was coming out of my building one day, and it was a small company then. You know, it was 1200 people, and his car was parked near mine, and so he stopped me in the parking lot, and we talked a little bit, and then he asked me if I'd give him my phone number, and I said yes. And he said, well, you know, I was looking at my calendar, and I was wondering if we could go out two weeks from this Friday night. And I was really, I mean, I was 23, I just joined the company. I was like, two weeks from Friday night. I have no idea what I'm doing. I said, and I teased him. I just said, that's really not spontaneous enough for me. You know, why don't you just call me closer to the date? You know, but here's my phone number. And so about an hour later, I got home and he called me, and he said, okay, tonight I have this event, and then I have a user group event, and then maybe we could get together for drinks at like, you know, ten o'clock somewhere downtown, and I said, all right, that's pretty spontaneous. I'll try that. And it was immediate click? I would say immediate chemistry, but he was dating other people. I was, it was complicated. Okay. Well, we dated for about five and a half years. And you talk about your conversations, the churning that you said you talked a lot about, or he talked about biology. I mean, talk about those kinds of conversations that you had. Well, we, you know, it wasn't that long actually, even after that, maybe four months, that we started vacationing more together. And, and Bill took very little time off back then. But we'd squeeze in these, you know, weekend three day trips or, you know, eventually started to take a bit more time. And Bill would always take, and he still takes, I teased him about this, he still takes this huge tote bag of books. And, and he reads voraciously. I mean, he loves to read. And when he's at Microsoft, he didn't get to read as much like, so on vacations, we do a lot of fun stuff, but he'd read a lot. And quite often, they were biology books, whole biology books. And Bill feels like if he, he knows if he knows something, if he can explain it or teach it to somebody else, because he said, if you know something deeply, and then you can explain it in a way somebody else who doesn't have a biology degree in that example, then you know, you know it. And I love to listen. So I, and I'm not going to read a whole biology book, but I learned a lot about the immune system. And, and Bill always loved biology. And he also would say, you know, one of the things when he's working at Microsoft, I wish I had more time to be around scientists, like maybe one day we'll have more dinners where we have people from UW come who are scientists. So it's interesting to me today that in the foundation, one of the groups he spends a lot of time with scientists. That's interesting. And you too, is that something that you were drawn to? Well, yeah, I'm a computer science background. So I love the science piece of it. And I believe, I mean, Bill and I both believe that some of the advances we're getting in the world are because of the innovations of science. If you didn't have the greatest biology, you wouldn't be able to get a pneumonia vaccine or a diarrheal vaccine. We wouldn't even be able to go after. We wouldn't be on the edge of being able to eradicate polio without the technology. We can talk about that more. So it's those advances and those innovations. So I love that piece for what it can do. But then I spend less time in the science meetings these days because I also love the piece of how do you get that amazing science delivered on the ground so somebody will accept it and actually use it. And that's a really tricky cultural social problem or social opportunity, social behavior change. And I love that piece kind of the cultural anthropology of it. And you took your first trip to Africa when you guys were engaged. Describe that. Yeah, we had the trip planned and then we got engaged in March and we went in September and we took about five, four or five other couples with us. And the whole goal of the trip was just we'd never been to Africa and we wanted to go do a safari. And it was the most time billed ever taken off from work. And we did an amazing safari. Love the animals. We love the savannah. But you couldn't help but be touched by the people. And you couldn't help at least for us, you know, to start asking questions. Like why is it that, you know, we were in then what was Zaire, it's now Democratic Republic of the Congo. Why is it that we were seeing whole towns just sort of boarded up and shut down that there used to be storefronts there? Like what had happened here? And why when we would be driving on one of the few paved roads, we'd see all these people walking to this open air market. But I mean, it was just everybody in our car, the men and the women were just struck by the fact that the men had on flip flops and were often smoking. And the women often have a huge pile of something on their head they're carrying to market and either a baby in their belly or one on their back. And we kept saying, why, why is that? And then on very late in the trip, it was actually ill one day and it stayed back in the tented camp, which was unusual. But the rest of our group went up to see the messai and were up in their village for a good part of the day. And I went in one of the huts where the women were cooking and like, you know, the smoke is just overwhelming. I didn't even know how that could hardly stay in it. And we stayed up in this village for quite some time. And it was really amazing to learn about their lives, etc. And at the end, one of the young men asked our group as an honor. He said, would you come back in a few weeks? My sisters were gonna have a cutting ceremony for my sister. And I just, we were all devastated. And it made me realize that I knew nothing. I knew absolutely nothing about that culture. And so I would say it started Bill and I on a series of kind of a learning journey. We always knew we would do philanthropy, but Bill always said it would be when he's in his 60s. He's not 60 yet. We'll be this year. But it started us on a series of learning journey and questions. And yeah. So when you came back and between that and starting the Gates Foundation, what did you do? What was your journey during those years growing out of the Africa trip? I think we, um, coming out of the, should we pause? Just want to see if we need to pause. Okay, we're good. Okay, okay. Great. Hopefully everything will turn out. Okay, there. Okay, after your Africa trip, and the intervening years where you're having children to and kind of busy. Yeah, three children. So after the Africa trip, it wasn't too long thereafter. We asked Bill's dad, Bill's mom passed away shortly after we were married and she'd been ill with cancer for that year. And we asked Bill's dad whether he would be interested in and just starting, we were getting so many letters from people asking for donations. And we asked Bill's dad, would he be willing to help us with that? And he said he certainly would. And we started to work on just kind of a series of questions we had. And he would put together groups to help us learn about things. And but I think one of the things that really struck Bill in me is we read an article in front of the New York Times one day on a Sunday, and we looked at the article and and we just said, how is it that so many children over half a million children are dying of diarrhea? We're like, okay, in our country, don't you just basically go down to the pharmacy and get something to take care of it over the counter? How could more than half a million kids be dying a year of something like that? And that we sent a question actually to Bill's dad and said, can you help us learn more about this? And he pulled a group together for us to teach us about vaccines and what had happened in that system and not. And also to start thinking, he pulled a group together to help us start thinking a little bit also about family planning early on. Those were two areas we were interested in. And so we kind of started on a series of learning journey. And we also started to say to ourselves, well, how have foundations throughout history, what has been their role in terms of helping with kind of world issues? And so we started learning about those things. So 15 years since the founding of the Gates Foundation, we're looking at incredible strides. Since 1990, child mortality under five, correct, has been halved, much of which you've contributed to with vaccines and other health treatments. What kind of thinking do you think the Gates Foundation brought to this that helped move the dial? OK, well, so first of all, anything I say today, kind of from this part, if I say we, I want to be really clear that there is no work that our foundation does that is not an incredible partnership with others. We don't have an on the ground, present staff in countries. I mean, we have small offices, but we don't have staff who carry out the work, give out the vaccines, et cetera. We don't have, you know, we don't have a scientific pharmaceutical arm. So we work with pharmaceutical companies. We work with partners in India, partners in Africa. So when I say we, I want to be really careful because I don't want people to think that we're taking credit for all this because we just couldn't do it without some of it. Well, even you heard the groundwork that was laid here for all the HIV Aids work, right? I mean, that wasn't us. That was CS, you know, IS. And so, but in vaccines, just I think one of the things that we've brought to the field of philanthropy is this idea that in the private sector, you don't act without data. I mean, one of the things that Microsoft was, I knew exactly how many copies of word we were selling or not selling in a given month. And I knew how my team was doing based on that. I knew whether we had a hit every time we rolled out a product. So it was very unusual with Bill and I came to philanthropy and we would say, okay, there are these global numbers, but how would you know how to act? Like you have to really start taking apart the numbers and figure out where do you have data and evidence and where do you not? And how would you start to fill that in to know exactly where you would pinpoint and act? And so I think that is absolutely one of the things that we brought to the field. And then in vaccines, this belief in innovation. So I think two things to understand about the vaccine system, we started to study it. We started to learn how we'd had this incredible vaccine system, but it kind of crumbled over time. And the biggest donation Bill and I did in the beginning was a vaccine grant. And it felt like a lot of money to us. It was a lot of money. How much was it? Fifty million dollars. And that was a lot. That was like a really big grant press. And we had kind of two goals. One was between when a vaccine would come out in the United States or the UK, let's say, it was about a 20 or 25 year lag till it would get to a child in Africa. 20 or 25 years. We're like, okay, we have the tool here, but it doesn't get there. So something's wrong. Something's wrong. And what is wrong? Is it supply chain? What is it? Secondly, there were vaccines that needed to be created for the developing world that because the diseases didn't affect us so much, the farthest in the UK or the US or Europe, the pharmaceutical companies weren't incented to create those vaccines because they didn't see a market for them and they're market driven. They should be market driven. And so we said, we think there's something we can do about that. And we ended up creating a public-private partnership, a very large pool of money for vaccines. In fact, we just had a re-up of getting all of our global partners to commit. We just raised seven and a half million dollars for vaccines. But because of that fund, that pool of money, we could go to the vaccine manufacturers and say, we could incent them to work on, say, a diarrheal disease that was in the developing world and we could guarantee them a market that would pull it through that there'd be enough of a market there. And we asked them not to have the high cost markup that they have in the developed world but to take margin plus a little bit. But that little bit was enough because literally be hundreds of millions of vaccines. And so today, a new vaccine, say, pneumonia that's been created in the last seven years, now the lag time to get it out to Kenya, it was about one and a half years. And it has the specific strains that are needed for pneumonia in Kenya. And the two biggest killers of kids are diarrhea and pneumonia. So that's game-changing. And you and Bill just wrote your 2015 letter that you're going to double down on this bet that you've made to really tackle global inequity. I want to ask you about that in a minute versus poverty. But you're going to double down on that bet. And in the next 15 years, you're hoping that we see more progress in poor countries than ever in history and that lives will be improved. These are the lives that will be most improved, which interesting, like this flies in the face of the argument that the rich are getting richer, they're the only ones benefiting from the way the global economy is going. Talk about that. Well, in these developing countries, it is so palpable when you're on the ground the change that is happening. It is, and when I talk about the developing world, I mean, you know, Africa has a lot of countries in it, and they can be very different. But the ones who have good rule of law and good governance, which we're seeing much more good governance in Africa than we used to, those countries are developing and changing. And when you're on the ground, you see not just the, you see absolutely the urbanization that's happening, but then it's the peri-urban areas and the way it moves out to the rural areas that a woman or a man who's living out in a rural area taking their goods to market, there's a market to take those to, so if they have access to that market and can sell their crop because they're predominantly farmers, they get more cash in their hands that they can then use either there or in their local area. And so for them, life is changing. I mean, when you go out to the rural areas, so I'm out in the developing world minimum two times a year, but quite often four times a year. Africa, Bangladesh, India, I'll be in Indonesia this year. And when you sit down and talk to people about their lives and what they dream about, almost to the 100% level the answer I get is educating my kids. Because if I can educate my kids, they can get out of this situation and they can move to the urban area and they can have a different life than I had. So there's an understanding that wasn't there 15 years ago? And a reality that wasn't there. The fact that we finally have almost parity for girls and boys at primary school, that we've invested in primary schools as a world. Now, we need to get the quality up for sure. And we have a lot of work to do as a world at the secondary school level. But they can start to say that dream could be a reality for my family. Because they'll have one child who will go off and it changes their circumstances or their neighbor will. And even just cell phones. I mean cell phones are so ubiquitous now in the developing world. I'll be out in a rural area where you're sitting in the dust and their chickens run around and somebody's cell phone will go off. And then somebody else's will, right? Will cell phones change things for people? Both, we talk about this more, but both in terms of the information they can get and the mobile money systems are being built out where you can start to save a dollar a day, two dollars a day, and it hooks up to a bank account. That is a game changer for a man and a woman. Yeah. So now we're going to move on to really the news of today, which is that you want to, you want to put women and girls front and center in development aid. Now it struck me hearing this that there's a lot of talk already about putting women and girls front and center. There's a lot of companies, Goldman Sachs, Coca-Cola, who focus on developing women entrepreneurs. There's a lot of studies that have come out showing that investing in women and girls pays off. What do you, you're taking, you're saying it's not as front and center as it needs to be? Tell me. No. I think we are making strides absolutely in the United States. And I think the things that Goldman Sachs are doing, cocas is doing, are fantastic. Unilever for girls and for women. But there's a big but there. I mean, we're talking about a very wealthy country, the United States or the Nordic countries in Europe. They do amazingly with women and with girls. But making the world equitable for women and girls all over the world, we're not even close. And so we have to think about both what do we want for women and girls in our own country? What are our dreams and aspirations? And how do we make that happen? But also how do we make it so that women and girls are front and center on the global health agenda? If you ask anybody who's been in this global health field for a decade, we didn't raise money for women's issues before. I mean, it's really, we just didn't. We didn't have maternal and child health on the agenda in as strong a way as it needed to be. We didn't raise money for women. And girls weren't even talked about before. It's really the Nike Foundation and many, many others who said, we need to be focusing on adolescent girls because they are 15 million of them get pregnant before their 19th birthday and they are the ones who become mothers really young and have to raise the family. And so how do we get them on the agenda too? So it's only been in the last five years that we really have just begun to raise money for women's issues and are putting girls on the agenda. And there's a lot of work to do. And you're, but you're going to talk about the concrete steps that you are going to take on this front. Well, I wrote a piece in Science Magazine last fall to try and explain where the foundation has been on this issue, to be very transparent about what we've seen, what our partners are teaching us. But really is a signal about where we are going as a foundation. So if you look back in our history, we really started as a research organization, as a science research organization, the power of innovation, the power of science. And at the end of the day, Bill and I still 100% believe in innovations, getting those innovations out. Then we shifted and did that and delivery because we said if we have the greatest science but a woman won't allow the polio drops in her child's mouth or allow the vaccine, then the great science is going to sit on the shelf. So we've shifted to do also delivery and we're still learning about how to do delivery really well with our partners. And what I'm making sure we add on now is this women and girls lens. And one of the things I'm doing both internally and externally, so we're just beginning actually this work. It's not that we haven't focused in our individual strategies some on women and girls, but we haven't put them front and center to say, how would you knit our strategies together? And we sometimes make false assumptions. In some of our strategies, if you don't put what's called a gender lens on it. So let me give you an example. In agriculture, we have new seeds that are coming out like there's a new May seed that's drought resistant. You get 30% more yield. If we assume by getting the seed systems up and running in Africa and getting them out, if we just assume, okay, we know half of the farmers in Africa are women. If we just assume they're going to get the seed, that's a false assumption because the agro dealers in Africa reach the men but they don't reach the women. So you have to program specifically to say, how am I going to reach that woman? So I put a challenge grant out inside the foundation to get all of the groups to come forward and say, where do we have good data and evidence that investing in women would give us more impact? And where do we not? Where do we have data gaps and we need to fill those in? So I'm doing that internally with the organization. And then externally, we used a mechanism we have called the grant challenges, which we've had for a long time in science. But I put out a call for proposals and I put some money out to say we have this investment we'll make and just call for proposals around the world. If you were going to make investments in women and girls, what are some innovative ideas? We got 1,700 proposals from just the developing world, 600 of which were amazing and worth funding. What were some of those innovative ideas? Some of them are saying, menstrual management and hygiene. How are we going to do that? How are we really going to help women? How are we going to think about really locating toilets? We are part of a group that's coming out with some new toilets over time that are not water. You don't need a big sewer system and water. But how do you locate them in a place where it's safe for women and girls? How do you stimulate the community to keep the uptake and the upkeep of that? That's something we hardly even talk about. I mean, come on, women all over the world every month are dealing with this, right? And they get a lot of infection from not being able to take care of their menstrual management and hygiene. So just looking at that issue and really looking at the data, the hardcore data that we do and don't have of really how many days do of school do girls miss if there's not a latrine there because she's got to stay home and deal with that. Oh, that's interesting. Any innovative ideas on family planning, putting off births? I didn't see any specifically in that set of proposals. We're doing a second call, a second round on these two because you don't always get the best one. You have to get the news out. We'll do a second call. I am seeing some innovative things, though, because in a separate group we're putting research and development money in family planning. And we can talk about that. And I do see a couple of innovations coming. And I want to get to that in a minute. But staying on the economic front, you've had time through all of this to think about the unintended consequences of supporting women economically. It kind of trickles down to the family and can affect the family balance. Definitely. Talk about that. OK, so again, let me just put a little asterisk in here. First of all, I really like men and boys. I have a son. I have a husband. I adore. I have many, many men that I work with. And again, some of these are gross generalizations. But if you look at the data, so I definitely, when I'm in Africa, you see relationships that are, you know, you see some healthy relationships that are somewhat equal in the households. But the more I talk to women, I try and do men's and women's groups together where you sit down and talk with people. And then I also do the women separately. And it's so interesting when you peel the men off what the women will really tell you that's going on. But the inequities are there in a huge way. And I'll give you an example. Women will tell you that, and we know it from the global data, when there's a health shock in the family, a child gets malaria, for instance, or gets sick, it's the woman's household finances that need to pay for that usually. And so usually the women will tell you, I negotiate with my husband once a year. We decide how much money is going into the family household, and then I manage it. But she'll say, you know, if I run out, we have three episodes of malaria, and I run out, I have another negotiation to do with them. And he'll say, well, where did the money go, right? And so one of the things we have to be really careful about is even as you put a new crop in a woman's hands, she'll tell you if my husband is the one that takes it to market, if I feel like it's a violent situation and I can't walk to market and he takes it and he gets the cash, I have a renegotiation to do with him over the household finances. So what used to be my crop that I would sell at the farm gate, maybe I get less money for it, but it might be better off for me to just keep doing that than to use this maze, you know, where I'm gonna get the corn, where you get 30% more yield and it's drought resistant. I may not wanna grow that because even though I'll get more yield, I could potentially get more income. If it gets in my husband's hands, it may not get back to me or to the kids. And so we know, from this we do know from good research, for every marginal dollar a woman gets, she's 90% more likely to plow it back in her family's hands than her husband is. She's the one that makes those deep investments in health and in education for her kids. But as you allude to, this all has to involve men and it has to involve men at the community level. How do you address that? Well, and I've seen some amazing things going on in villages. I mean, you have to remember how even we learn in our own society, right? We all have cultural assumptions that we've always just assumed, okay? You just assume that's a woman's role or that's how things are divvied up. But when you bring a village together and they start planning together openly and you start injecting bits of information and education about yield on your farm or kids' health, the moms and dads have the same goal, which is to have healthy children grow up and thrive, go to school and thrive. That is a common universal goal. And if you can get them to start thinking about that goal and then to start to look at their own lives and who does what on the farm and whose responsibilities or whose are, okay, if we wanna save the child's life, it means, I'll give you an example. In Malawi, I saw this in the village, they literally had a piece of butcher paper out. They were down in the dust and they were planning. What they had realized was that more women were dying in their village in childbirth, they had been taught that if they took them to the clinic because the government was making the clinics better in Malawi, we know this all over the world. If a woman gets to a clinic, a very basic clinic with a woman with a little bit of training, the woman who's pregnant is more likely to survive the birth and the child is likely to be more healthy. So the village said, yes, we have that goal. We wanna get our women into clinic. We wanna, you know, it'll be better for the women, it'll be better for the babies. And then they started to self-identify. Well, what keeps us from doing it? Well, we don't have the transport fees. We haven't saved them up. Oh, we don't have a motorcycle or a bike together there. Oh, in the rainy season, the river swells and we don't have a bridge. Once they have that shared goal and they started then doing that and seeing they're women healthier, they're babies healthier, then the real empowerment happens. Then the village starts to say, well, what do we care about as a group of men and women? And it was really interesting. This one village, and I've seen this, I just saw this in India too. This village said, we don't like that the men are beating up the women. That's not acceptable. And as they thought about it more and talked about it openly, the men said, well, it's our job. The only people that can stand up to those men, if we hear a man being violent to his wife in a house, it's our job as men to go knock on the door and take that man to task and say it's not okay. That's when you get empowerment, is when the village decides what they wanna do together and what they care about changing, then you start to get real empowerment for women. And sometimes you can do it with a mixed men and women's group, and sometimes you can do it just in a women's group and then bring it back to the village. So fit family planning into this because of course we know that women have a much lower chance of being in poverty if they put off that first birth, if they space their later births. Family planning was on the Gates Foundation high level on its mission early on and you feel like it isn't enough now and needs to come back on. Has come back on. Has come back on. So the two places Bill and I had interest in we started were vaccines and family planning. For some internal reasons I won't go through. We were doing family planning, but not at all at a big scale. And it was really interesting as I would travel around the world and talk with women, I would be in their village for several hours and I would be there to talk to them with my questions about vaccines for their kids. Those were my questions. And if I stayed long enough and let the women ask me questions, they would so often bring the conversation back around particularly in Africa to what about that shot I used to get in my arm? And what they were talking about was Deepro Prevera. It's the predominant form of birth control used in Africa. It's a shot that you get once every three months. And the women would be outraged because they'd say it used to be there, that little clinic you can see over there, it's not there anymore. It's I have to walk 10 kilometers to get it. I have to make up some excuse to my husband of why I'm going somewhere because a lot of women will tell you they're using it covertly because they'll say to you, it's, you know, literally I had a woman in Niger say to me, look at what I have. I have five children. My husband has gone off to try and get work. Look at my farm. I have nothing. How can I feed these kids? I can't have another child. It's not fair to these kids. And so it was this life and death crisis for them and their families. And when I would come home, I started to look at the global statistics and it was really odd because again, the statistics were weird. It was said that contraceptives were stocked in. Well, because of PEPFAR, in fact, condoms were stocked in, in Africa. You could get condoms, but women will tell you over and over again, I can't negotiate a condom even in my loving relationship because I'm either suggesting that I fear my husband might have AIDS or that I have AIDS. That's interesting. And so as I looked at the statistics, I said we have got to get family planning back on the agenda. And so I set out with a group, took a year and a half to really wade through what the issues are. And in the end, we raised $2.3 billion. In 2012, we put a women's issue on the agenda. And with our goal is to get 120 million women voluntary access to contraceptives by 2020, 120 million women. And I think what I learned through that journey, which took a lot of courage and a lot of deciding what we wanna do as foundation, what I wanted to do personally, how I wanted to speak, is the thing that kind of shocked me about it was, I thought, okay, we're gonna get to this family, London Family Planning Summit, lots of governments put money into this 2.3 billion. And I thought, okay, we finally will be there. Like, we have to get these 120 million women on contraceptives. And I want more after that, but okay, we finally have the funding, we're finally there. And it turned out it was just the beginning of the journey. I mean, I was in Niger and Senegal right before I went to London, literally on the way, because I like to get grounded in the issues. And I could just see, it was like, oh my gosh, there are so many more issues for women. Like family planning is a really important issue, but it's the tip of the iceberg. And we have so much more work to do. You're a devout Catholic, and so putting family planning on the agenda, talk about that and your decision not to fund abortions. Yeah, so I've said this publicly, I believe in contraceptives, I use contraceptives, I have three children who are each three years apart, 19, 16, and 13. I was lucky to be able to have three kids and they were spaced. And for a woman in the United States, I think it's something that we take very for granted. But why could I work? I mean, if you can time and space the births of your children, you have economic opportunity. And in the developing world, the chance those kids will be healthy is just phenomenally different. The chance will be alive. The fans will be alive and be healthy if you can space the births and time them. So as a Catholic, I knew I used contraceptives, but it's not the most, it's not talked about very much, it's not like I wanted to be on stage. I kept looking for the person who would bring this issue forward. I kept saying, we gotta find somebody, and I couldn't. And I finally realized I needed to speak out. And on the importance of family planning. On the importance of contraceptives and family planning. And I knew in the U.S. that the reason, I mean, let me say this, the reason on the global health stage that family planning, which was so important and was on the global health stage in 1970, and there was a consensus around contraceptives. A bipartisan consensus. A bipartisan consensus. That had completely crumbled and the world stopped investing in contraceptives because of the controversy in our own country. Because abortion had gotten attached to contraceptives. Instead of saying, no, no, no, we had consensus around the one piece we can agree to. And so I thought, hey, the thing we gotta do for women is get contraceptives back on the agenda. And I started to build support for that in Europe and in the United States because it is the piece we can agree to. I'm Catholic, 94% of married Catholic women in the United States use contraceptives. They may have different points of view, women do, and for good reason, men and women on abortion. I completely agree. But contraceptives we agree to. And 200 million women, married women, are asking us for them. 200 million. And to me it was like, I travel to these places, I can't turn my back on that. And so I talked to my, I talked inside my marriage, which there was no controversy there. I talked to my kids about what I planned to do and that I was gonna be more public about this. And I talked to my parents, quite honestly. And again, I knew my parents believed in contraceptives. And I wanted to make sure everybody was on board that I was gonna take on this, but it's just the right thing to do. My Catholic grandmother believed in contraceptives. Yeah. Mobile phones, we touched on that. Can you just talk about the importance of that to improving women's lives in particular? Vastly important. So I'm sure most of you have heard of these amazing village savings and loans groups that exist all over the world, Bangladesh, Africa, India. Now that mobile phones are out there and pretty ubiquitous, women for them, so the numbers right now, but it's getting better all the time. So I think it'll be remarkably different in five years because the cell phone companies are focusing on it. Women today are about 21% less likely to have a phone than a man, but that gap is closing. When you take a village savings loan and they have access to mobile phone, even if not all the women in the village savings loan have access to phone, but as a group they have access to a phone, they can take that cash that they keep in the lock box with three padlocks where you get two digits, you get a key, I get a key and somebody else gets a key for those three padlocks so that the money's safe. They can take that money out of that little metal box and they can put it, they can store it digitally on their phone and so of the six digit pin, none of us know the six digit pin, but you might know two digits, I know two digits and she knows two digits. Now all of a sudden our village savings loan, our group of 10 or 12 women, we have access to mobile money and that money then we can start to not only lend but we can save, we can save a dollar a day, $2 a day, you don't have to put your assets in a goat or a cow or a piece of jewelry that when the market drops on the price of cattle, you're not gonna get the asset, the money out when it's time for the school fees. So being able to save digitally and it hooking up to a bank account will start to change everything for women because women are not welcomed at the bank, their money is stolen when they get on the bus to go to the bank, they have to pay the transport fees but if they can be out in their village and they'll tell you if my husband gets a job in the city, they go in Nairobi and get a job, they can send the money back to me on my phone. Well then it comes time for the school fees and you've got it. Or the hunger season happens and it's like wow, I have money to go buy more crops on the market. And so what it will do for women, when women get a little bit of cash in their hands, their power inside the family changes, the dynamic changes, whether it's in India, the power dynamic with their mother-in-law, whether it's with their husband in Africa, it changes and again, they invest it in the health and education of their kids. And then mobile phones, I mean the other thing, one of the apps that's happening now and again, as those phones, they're the basic plastic phones in Africa today is what I see but smart phones will happen too. And when that takes off, the applications for women, there's an application right now that violence, one in three women experience violence in their life around the world. But one of the applications that's out is you can have six trusted people in your circle of friends, men and women, have your phone number and if you push one button on the front of the smartphone and you feel like you're in trouble somewhere, but instantly messages go out to those people. That is a game changer for women. So when you think about what will come and the neat thing, just one thing back to mobile money, mobile money is happening. Kenya, Tanzania, Bangladesh, Philippines, India just opened up its regulatory environment. In Kenya, it's close to more money starting to move through that system than the normal channels. That's incredible. So it's happening. I wanted to range before, we are gonna open this up to questions in about 10 minutes, but I wanted to range across a couple other issues while we have you here. Food security, there's a rising controversy about GMOs, but you all believe that GMOs are an important piece of feeding the global poor. Talk about that. If it wasn't for GMOs and the work that Norman Borlaug did, we will have so many million people going hungry. I mean, today, two billion people still go hungry every day, two billion people. And yet, if you have a new seed variety that gets 30% more yield or a rice variety that as the farmers will talk to you in Africa about, especially if they live near the equator, that the rains are coming at different times and when they come, they're coming torrentially and then they have a drought. And a lot of farmers in Africa plant maize corn, they actually plant rice too. And so if they can get a flood resistant rice so that when the patty gets filled with water, but there's a tolerance for both salt and flood resistance, they still lose, completely lose their crop, they can feed their family. And if they can store a little bit of that crop, then again, as you can imagine, the farmers are all putting their maize on the market at the same time. It all comes due at the same time or the rice, but if they can store a little bit, they can tide over the hunger season and then as the prices go back up, they can start to sell it on the market. Without GMOs, you can do some of this work and some of it's absolutely being done with non GMO crops, but it's really that genetic breeding. I mean, if I go into the store today, which I do, to buy corn for my family, if you go back and look at the history of corn in the United States, the little tiny cobs and the terrible little kernels we used to get out of them, I mean, you wouldn't be able to feed your family on those corn cobs, but we use GMOs today. We have benefited as a world. I mean, what lifted parts of Asia and Latin America out of complete poverty? It was getting their agricultural systems working and being able to feed their people. You can't have two billion people on the planet hungry. And yet, if we get them genetically modified seeds in appropriate ways and they plant them right, they can lift themselves out of hungry. So I definitely believe in GMOs. So how do you address the criticism that there can be resistance to pesticides? And how do you, and are you concerned about the rising protests against GMOs? It's gonna set back these efforts. I am concerned about the false advocacy that happens with GMOs. That does concern me. And pesticides, I mean, again, a farmer in Africa, those pests are killing their crops, right? So if they don't have to use as much pesticide on their crops, that's a good thing. Or here's another example, cassava. They get a, so another huge crop grown in Africa's cassava. We don't grow cassava here. And yet we have modifications coming on cassava that keeps them from getting the number one disease on cassava. It's a mosaic, they call it mosaic disease. What happens is the leaves just shriveling. When you pull the crop out of the ground, it's tiny instead of a big cassava root that they eat. So we have to get, I mean, we have the technology, it's not harming anybody. I think the thing to think of this, like, is the, you have to have an incredible regulatory body for GMOs, which we do have. Just like vaccines, vaccines you put directly in your body. We have an amazing regulatory environment that makes sure those are safe. We have a regulatory environment in the United States for GMOs. And what we're working on in Africa is both increasing the number of PhDs and masters in agronomy and helping them open up their own regulatory environment because the Africans have to decide for themselves in Kenya or Tanzania, is this what we want for our people? It's their decision, it's not our decision to make, but we have the technology and then they have to do, understand safety-wise, is it something they wanna use? But how could we, for me, it's like, okay, I can go buy, I eat genetically modified corn. How could I say to them, we're not gonna give you the seeds and let you open your own regulatory environment and feed your people if you think that's right? That doesn't make any sense to me. Something else we've been outspoken about is this anti-vaccine movement. What do you say to them? Well, look at what happened when we got measles at Disneyland. Says it all. It says it all. I mean, why are people, why are kids living in our country we don't have polio in this country. Do you know what happened when polio hit? Our kids aren't dying of whooping cough. Our kids aren't dying of measles. We just, we take it so for granted and then you get this tiny little group that says, hey, I don't think I should give it to my kids. Well, I'm sorry, the rest of us are giving it to kids and my kids getting it are helping keep your kids alive too because there's herd immunity in some of the vaccines or there has been in the past. So, I think we want a measles vaccine to be used widespread in the United States just like the other tools that we have that are saving our children's lives. You mentioned polio. Where are we on polio globally? Polio is an amazing story. We are at the last tiny piece of the mile. So India was certified. So there were four endemic countries. If you look back five years ago, there were still four countries where we'd never eradicated polio. And one of those was India. India was declared certified polio free three years ago. In Nigeria is another one, huge country, a lot of terrorism. You know the issues in Nigeria. We haven't had a case of polio in Nigeria since July 24th last summer. Not a case on the continent of Africa since August of last summer. So we are knock on wood, hopeful about polio. And the last big place that has it is Pakistan, but they're down from over 300 cases last year to so far 22 cases this year. And so we are getting very close. And if we can eradicate polio, the only disease that's ever been eradicated, human disease has been eradicated from facing our smallpox. And if we can eradicate polio, I think it says in global health, we can make a great achievement. Like we can do something if we put our minds and our muscles to it. And the technology partly is helping, the mapping technology, the cell phone technology is helping us, but it shows that we can make gigantic progress in global health and that gives us momentum in other pieces of global health. And the Gates Foundation was very active in the Ebola crisis. Where are we on Ebola? Yeah, so Ebola, I mean, as you know, the cases, some of the countries now are Ebola free. The cases have come way, way down. I think the lesson that comes out of Ebola though is this primary healthcare system has to be built up. So the four countries that got it so badly don't have a built out primary healthcare system. When I talk about primary healthcare system, I need a little health post out in a most remote rural area that's about four times the size of the stage. And staff with two healthcare workers, usually women. If you have that system where they're trained and then you can refer people up in the system as they get sicker and sicker if they need to go to a hospital, that works. It works all over the world. Nigeria, if Ebola did go to Nigeria, if we had had a big outbreak in Nigeria like you saw in Liberia, we would be talking about a whole different situation today in the United States. We got lucky as a world. And honestly, what had happened, all the groundwork that had been laid by UNICEF and WHO and CDC on polio in Nigeria, as soon as they saw that case of Ebola come in, those doctors and the Nigerians said, oh my gosh, take the polio clinics, convert them to emergency response, do immediate contact tracing, find out everybody quarantined the people who were around that person. They were able to tamp it down in Nigeria because they had that vaccine and still not a great primary healthcare system, but they had enough in place to keep it tamped down. So to tamp it down in the largest economy in Africa is a pretty important moment. Over 100 million people, right? I mean, wow. We are going to open it up to questions. Questions have a question mark at the end. They have to be short. And please identify yourself. And there are mics coming around. Are there mics coming around? Yes, right here. Good morning, ladies and gentlemen. Good morning, Melinda Niskes. Thank you so much for your wonderful presentation. My name is Rosemary Seguero. I'm the president of an organization called Hope for Tomorrow. We focus in the rural areas of Africa. I come from Kenya. Thank you for helping my country and Africa and the world in general. Since we focus on conflicts and violence and empowering women, you know you've talked about the rural areas. You know you've gone to the rural areas of Africa. How can we work with you in the rural areas of Kenya and other African countries? More about our information in the rural area is here. You will read it by yourself when you go. Thank you. Great. Can you hear that? The mic was a little close. Yeah, so just follow up with I have staff in the front row. So if you want to give us some information about your organization, I think starting these women's self-help groups, there's 600,000 women in Mali in these women's self-help groups. As an example, they work. They work in India, Bangladesh, they work in Africa. And I think if you get those women in these self-help groups and you start putting in pieces of education about health or agriculture, they eventually the women get to the point where they empower themselves and they start to say, okay, I'm getting more livelihood off my farm because let's say you start with agriculture, the agriculture interventions, then the women start to say, I just was back from India seeing a women's self-help group. They start to get to the issues they care about. And I'll give you an example from India but I've seen it all over Africa. I just came back from India three weeks ago, sat with a women's self-help group and a woman named Sabita said, she said, you know, before we had the self-help group, nobody in the village knew our names. We didn't know each other's names. She said, our men knew, we all knew the men's names. And she said, we used to hide behind our saris. And she said, now, because they had been getting more agricultural livelihood off their farms, they said, we can feed our kids. We have, we can say to our mother-in-laws, we deserve a better room in the house or we can move out. She said, I used to have one saris and I would wash it in ash. She said, I now have three saris and a bar of soap. And they said, when the police show up in our village, we used to turn away because we were so afraid. She said, now we stand in the road and we say, why are you here? What business do you have with our village? And the women in this village were deciding to eradicate alcoholism for their village. Working with the men and the women to say, we will have less violence if we have less alcoholism in our village. And their next step was, they were gonna go get a toilet in their village. And I thought, that's women's empowerment. And I see it all over Africa and I see it all over India. How are they trying to deal with the alcoholism? Just putting their foot down. So they would show up people's doors and say, this isn't okay. And they were going to the women who were actually brewing the alcohol. The women were doing it as livelihood, right? Because they, and so they were saying to the women, no, no, no, you can plant these other crops and this isn't good for our village if you are brewing alcohol. So they got, they tamped down the women who were doing it, gave them alternatives and then talked to the men, got the men on board to say, okay, yeah, we want something different. And I met a young man and he said to me, I said, his mom was in a self-help group. Her mother-in-law went with her first and then she started to be in the self-help group. You know, I said to this young man, he was 15. What is, what's it meant to you to have your mom in a self-help group? He blew me away. He said, my mom saved me from alcoholism. He said, I was headed down that path and my parents both wanted me to get an education but I was drinking a lot and she saved me from it. And I thought, wow, there's the power of a self-help group. And involving men. Yeah, exactly. Right here in the. My name is Agnes. I'm civil engineer and I'm from Democratic Republic of Congo. Thank you very much, Melinda, for all you are doing for Africa. I don't have a question. I have a request. We are. Short request. Is that a request? He said not a question. Request. I have a request. Quick. Yeah. We are African diaspora from Africa. We are American citizen here. We don't have anything to tell you. You are very worried about African women and girls problem. We have some suggestion. So we want to work with your staff because we can't express all our suggestions here. Please, we want your staff to listen to us. We are there from Africa and we want to make some suggestion because in Africa there is a problem of culture and environmental. And I support the women's development network in Africa which is supporting women grassroots leaders on the ground who will hook you up after this. Katie, who's in the front row, will help you hook up with that group. Thank you. Okay, thank you very much. I realize I'm ignoring this side of the room. Right there in the white scarf, you. Yes. Hi, thank you so much for being here today. I wonder, you talk about family planning as. Could you identify yourself? I'm Sabrina Winder. I'm actually with the State Department. You talked about family planning as sort of the tip of the iceberg for you. And I was struck by your comment about the FGM cutting ceremony as sort of being your spark into this. Can you talk a little bit about the foundation's work in gender-based violence and social norm changing? Sure. Well, let me just say this about women and girls. I think of this work kind of in three areas. I think of it as health. They have to grow up and live a healthy life. Their children have to be healthy because if they don't do that, you can't even move on to the other pieces. So healthy life, I think about, do they have the ability to take and make a decision in their own household about themselves and their family? And then I think about, do they have economic opportunity? If you can help women in all three of those areas, then you have an empowered woman. And so whether it's, and to do that work requires innovation sometimes. For instance, in health or in agriculture, in new seed, but it absolutely takes social and behavior change. So for instance, one of the reasons I keep talking about these women's self-help groups, so today, if you look in India, there are about three million women in self-help groups via private NGOs. The government, and everything I talk about, just so you know, we think of the foundation as being a catalytic wedge and then governments have to scale it up because they have the big money and they have to do what works for their culture, right? So in India, the government has a goal of setting up 30 million women's self-help groups. And we think about 10 to 20 women in each of those groups, 30 million, that's when you get social change. And that's why I think they're so powerful if done right. And we're looking at how do you create more of them in Africa? Okay, 600,000 women in Mali, that's good, but I want big scale. And so if we can do, we do a lot of the social change through these self-help groups, and that's when you get to the decision-making piece and that's to me when you start to get to the economic pieces. And you can get to some of the very difficult social issues like female genital cutting actually through a self-help group. Mike, right here. Good morning. My name is Irene Barrick-Rica, the executive director of Enable. We train blind students in Kenya on basic computer skills. So we have about 1,200 students and I started this program because I discovered that they're blind and visually impaired. When they graduate from high school, they become beggars and they get into prostitution. So most blind women have four or five or six children and no income. But what we've discovered on our program is that the blind students do love technology. Some of them are even learning web development, but there's a challenge in terms of they lag behind. So I'm wondering whether you've been able to invest on any technology program for girls with disabilities, especially in Africa, and at the same time, is there any research being done to sort of figure out why are girls lagging behind in technology and especially those disabilities? Thank you. Okay, those are big questions. There are a couple kind of packed in there. So let me just say this. In the United States, we actually absolutely on the technology side, there are a lot of work is being done by Microsoft for handicapped people and blind people. So I kind of leave that on that. What we do on blindness in Africa and around the world is give vitamin A supplements, and particularly through Helen Keller International, vitamin A supplements, if given to kids twice a year, prevents blindness. So the huge predominance of blindness in Africa comes from lack of vitamin A. We don't have that problem here because we fortify our milk, right, with vitamin A and vitamin D. So in Africa, we're making sure the supplements get out and then we're going, we call that upstream. Working before somebody gets blind, you work upstream and figure out how do you not get them in that situation? And then we're working even upstream of that. We have a sweet potato variety right now that is not GMO, that we've grown vitamin A into and we're getting that in the hands of women. It gives them more economic means, more livelihood, because they can sell it, it's a crop they can make more money on. And if they feed it to their kids, the kids get vitamin A. We're also trying to breed vitamin A into a rice variety and that should come out in about two years. We actually have the vitamin A bred into it already. We're trying to get the yield up so that farmers will want to grow it. But that's how we try and go upstream on blindness. And then we don't today, honestly, work on the downstream, the disability piece, because there are only so many things we can work on. So we're trying to prevent people from getting in that situation. Great answer. Way back by the poll, the pillar there. Thank you very much for doing a lot of things in India. And I just noticed. Can I get it by yourself please? I'm Dr. Krishna, one other from George Washington University. And in your talk, you mentioned about the innate immunity. You know, India is celebrating International Yoga Day. And you know, Ayurveda and yoga can transform the immune system of human. And that will have a very transformed personality as well as social and behavioral action. Thank you. So I would like to pay attention on that too. Yoga and alternative medicines in general contributing to healthiness. We don't work on that. I do meditate and I do do yoga. But I would just say this, the Prime Minister does have that in his plan in the side of the health office is to promote yoga. So it's interesting that he sees the benefits too. Okay. Right here in front. Hi, I'm from mental. Susan, stand up. No, it's okay, we're done. Okay, so her question was, thanks Susan. Her question was on, do we do work on anything on mental health? I'm just honestly starting to get the data on that more we don't today. But one of the biggest things I see in the developing world is how much women are suffering from anemia and suffering during, if they're not, so we're working on food security and working on nutrition for pregnant women and even pre-pregnancy because if a woman's not fed properly for pregnancy, it's devastating for her body and it's devastating for the child's body. We call that thousand days pre-pregnancy and then all the way through the first two years of life. But what we're seeing is a lot of depression in post-menopause, post-pregnancy, sorry, pregnancy time for women. Postpartum. Postpartum, unbelievable. And what it does to the women is not only does it affect them but how they interact with their child, right? So we're just starting to get the data on that. We're not doing anything yet is what I would say. But those are all issues that we're just kind of looking at as part of this whole women and girls agenda. Okay, the boss gets his chance. Andrew Schwartz, Senior Vice President of CSIS. Mrs. Gates-Wanina and I dreamed up this series. This is what we envisioned. Thank you for being here. You are the gold standard, the platinum standard. Thank you for being here. Thank you. My question is a simple one. I read your piece on Medium last week about Sabita who you mentioned before. I often find that in the United States there's not enough coverage in the media of all the issues we're talking about. What can we and what can the foundation do better to publicize these stories, to build more momentum for more things to actually happen? Yeah, thanks for that question. It's hugely important. I would also just add to that. I mean, I think a lot of Americans think that foreign aid is a black hole, as you know. And how do you get the message across that there have been gains? Yeah, so if you poll most Americans they think that we spend 10% of the US budget on foreign aid, 10%. And we spend actually less than 1%. And those dollars are really well spent. So we're trying to get the message out that those investments are making a difference. Why can we even talk about polio almost being eradicated? Investments. Why can we talk about vaccines being such a good, making so much progress for childhood deaths? It's those investments. But we need the public. Your point is exactly right. We need the public on board understanding that that makes a difference. Both humanitarian-wise, they need to understand that these economies, in Africa, a lot of the countries, they have the goal of growing from a low-income economy to a middle-income. South Korea has done that transition. And if we get them on the right path, aid isn't forever. So economically it makes sense. And selfishly, for our own peace and security, we want people to stay where they are. They want to stay where they are. So if they have the means and the livelihood and the health, they will. So one of the things we're just embarked on with our many partners, including the Global Poverty Project, but all of the NGOs in the sector, Save the Children, Care, Oxfam, World Vision, is an initiative called Global Citizen. And you'll hear us speak about this more and more and more throughout the year. It's to try and get many people, and particularly young people, and people who care about it, like in this room, connected to global development and global health in these issues to understand the progress that's actually being made, have a website they can go to to learn about more and get updates. But then to go and be activists. To say to our government, we care about this. We care about your investments in vaccines. We care about people not going hungry. We need that public will. So any innovative ideas you all have about how to get stories out, not the destitute stories. I mean, that's for me is what's so hard is I read, you know, on the front of, you know, a newspaper, let's say, you know, I read The New York Times, which they do amazing coverage, but it's always the destitute story. When I go to Africa, what I see is the amazing ingenuity and the change that's going on. And so somehow we need to get those pieces of the story out too. And it's those changes that are happening in part because of some of the investments, the infrastructure investments we're helping make as a world into their infrastructure of global health and roads, et cetera. And that's what will set them on their way to lift themselves up, which is their ultimate goal. And I think I speak on behalf of everyone in this room, you're probably the best storyteller on the Good News front. So, right here on the aisle. Yes, you? Hi, Glenis Long, I'm with the federal government, small business administration, but I do a lot of volunteer work with Rotary. And you've got an incredible wealth of intelligence right here in the room. How can you capture some of this information that all these people have in here to support what we obviously support you by being here? How can we take this one step further? I think of the World Bank and the SME Toolkit, I think of 4-H and how they started the original corn GMOs and the entrepreneurship. Because what I'd like to see, and I'm asking you, is how do we take the gender lens and bring forward this generation's innovative research for girls so that they can enjoy the benefits that you've enjoyed? That's a big question. It is. I think exactly what you're saying is, we need all the think tanks to be saying, this is the data and the evidence we have about why investing in women and girls makes a difference. Here's where we need to collect more data where we really don't know enough. So helping us gather and collect the data and publicize it is one piece of this chain. Another piece is just basically starting to collect up, okay, who are all the people investing in women and girls and how are they going about it and what should we specifically do? Because as you know, we're talking about a myriad of issues. We're talking about three dozen different issues. And no one person is gonna be able to invest in all of them. You have to have partners who invest in child marriage, partners who invest in making sure that we have a better water supply for women and sanitation, et cetera. So helping the partners align is another place that we quite honestly could use some help. So two suggestions. Unfortunately, I'm really, I'm sorry to every, I know there are a lot of people who wanna ask questions and unfortunately, we've come to the end of our time. So I wanna just kind of end on this note and with this question. Melinda, you've been so kind to share so many of your stories as you've done research over the years. Is there one story that stands out that's especially powerful where you can leave us with a piece of advice or a way to look at things going forward? Yes, I was meeting, I've met so many incredible women, so many. And it's funny, it's their stories, honestly, that propel me. I always try to think of them when I'm trying to talk about how to explain this. But I was meeting with a group of women in a slum in Nairobi and we'd had a lot of fun together. We were talking about, I was there to talk about contraceptives and family planning and they were laughing at me. Well, first of all, they're laughing at me because I was asking them about implants that they get in their arms. And they said, and I misunderstood what they were saying, I said, they said, yeah, we think of them like batteries in a radio. And I said, what? I said, is it like you feel like you get more power or something? And they said, no, no, silly. It's because they feel like batteries in a radio when they're in our arms, right? Anyway, we had this long discussion about the importance of contraceptives, et cetera. And at the end, finally this woman, Marianne, stood up and she was holding this baby girl in her arms and she said, you know, I wanna bring all good things to this child before I have another one. And she said that to me, it was right when I was on my way, actually to this London Family Planning Summit, I was on that journey and I thought, she captured the universal truth about parents. We want all good things for this child before we have another. And so I used her quote and when I think of her, whenever I think of what she said, I can think of her standing there strong and smiling with that baby girl and I think that's the universal truth that we're going after and that's why this work is so important. Well, Melinda, you've contributed so much to that work and to our understanding of that work today. Thank you so much. Thank you. Thank you.