On the basis that a picture

what I did was, I asked Bill and Melinda

to dig out from their archive

some images that would help explain

some of what they've done,

and do a few things that way.

So, we're going to start here.

Melinda, when and where was this,

and who is that handsome man next to you?

Melinda Gates: With those big glasses, huh?

This is in Africa, our very first trip,

the first time either of us had ever been to Africa,

in the fall of 1993.

We were already engaged to be married.

We married a few months later,

and this was the trip where we really went to see

the animals and to see the savanna.

It was incredible. Bill had never taken that much time

off from work.

But what really touched us, actually, were the people,

and the extreme poverty.

We started asking ourselves questions.

Does it have to be like this?

And at the end of the trip,

we went out to Zanzibar,

and took some time to walk on the beach,

which is something we had done a lot

while we were dating.

And we'd already been talking about during that time

that the wealth that had come from Microsoft

would be given back to society,

but it was really on that beach walk

that we started to talk about, well,

what might we do and how might we go about it?

CA: So, given that this vacation

led to the creation of

the world's biggest private foundation,

it's pretty expensive as vacations go. (Laughter)

MG: I guess so. We enjoyed it.

CA: Which of you was the key instigator here,

or was it symmetrical?

Bill Gates: Well, I think we were excited

that there'd be a phase of our life

where we'd get to work together

and figure out how to give this money back.

At this stage, we were talking about the poorest,

and could you have a big impact on them?

Were there things that weren't being done?

There was a lot we didn't know.

Our naïveté is pretty incredible,

when we look back on it.

But we had a certain enthusiasm

that that would be the phase,

the post-Microsoft phase

would be our philanthropy.

MG: Which Bill always thought was going to come

after he was 60,

so he hasn't quite hit 60 yet,

so some things change along the way.

CA: So it started there, but it got accelerated.

So that was '93, and it was '97, really,

before the foundation itself started.

MA: Yeah, in '97, we read an article

about diarrheal diseases killing

and we kept saying to ourselves,

"Well that can't be.

In the U.S., you just go down to the drug store."

And so we started gathering scientists

and started learning about population,

learning about vaccines,

learning about what had worked and what had failed,

and that's really when we got going,

was in late 1998, 1999.

CA: So, you've got a big pot of money

and a world full of so many different issues.

How on Earth do you decide what to focus on?

BG: Well, we decided that we'd pick two causes,

whatever the biggest inequity was globally,

and there we looked at children dying,

children not having enough nutrition to ever develop,

and countries that were really stuck,

because with that level of death,

and parents would have so many kids

that they'd get huge population growth,

and that the kids were so sick

that they really couldn't be educated

and lift themselves up.

So that was our global thing,

and then in the U.S.,

both of us have had amazing educations,

and we saw that as the way that the U.S.

could live up to its promise of equal opportunity

is by having a phenomenal education system,

and the more we learned, the more we realized

we're not really fulfilling that promise.

And so we picked those two things,

and everything the foundation does

is focused there.

CA: So, I asked each of you to pick an image

that you like that illustrates your work,

and Melinda, this is what you picked.

What's this about?

MG: So I, one of the things I love to do when I travel

is to go out to the rural areas and talk to the women,

whether it's Bangladesh, India,

and I go in as a Western woman without a name.

I don't tell them who I am. Pair of khakis.

And I kept hearing from women,

over and over and over, the more I traveled,

"I want to be able to use this shot."

I would be there to talk to them

and they would bring the conversation around to

"But what about the shot I get?"

which is an injection they were

which is a contraceptive.

And I would come back and

and they'd say, "Oh no, contraceptives

are stocked in in the developing world."

Well, you had to dig deeper into the reports,

and this is what the team came to me with,

which is, to have the number one thing

that women tell you in Africa they want to use

stocked out more than 200 days a year

explains why women were saying to me,

"I walked 10 kilometers without

and I got to the clinic, and there was nothing there."

And so condoms were stocked in in Africa

because of all the AIDS work that the U.S.

and others supported.

But women will tell you over and over again,

"I can't negotiate a condom with my husband.

I'm either suggesting he has AIDS or I have AIDS,

and I need that tool because then I can space

the births of my children, and I can feed them

and have a chance of educating them."

CA: Melinda, you're Roman Catholic,

and you've often been embroiled

in controversy over this issue,

and on the abortion question,

on both sides, really.

How do you navigate that?

MG: Yeah, so I think that's a really important point,

which is, we had backed away from contraceptives

as a global community.

We knew that 210 million women

were saying they wanted access to contraceptives,

even the contraceptives we have

and we weren't providing them

because of the political controversy in our country,

and to me that was just a crime,

and I kept looking around trying to find the person

that would get this back on the global stage,

and I finally realized I just had to do it.

And even though I'm Catholic,

I believe in contraceptives

just like most of the Catholic

who report using contraceptives,

and I shouldn't let that controversy

be the thing that holds us back.

We used to have consensus in the United States

around contraceptives,

and so we got back to that global consensus,

and actually raised 2.6 billion dollars

around exactly this issue for women.

(Applause)

CA: Bill, this is your graph. What's this about?

BG: Well, my graph has numbers on it.

(Laughter)

I really like this graph.

This is the number of children

who die before the age of five every year.

And what you find is really

a phenomenal success story

which is not widely known,

that we are making incredible progress.

We go from 20 million

not long after I was born

to now we're down to about six million.

So this is a story

largely of vaccines.

Smallpox was killing a couple million kids a year.

That was eradicated, so that got down to zero.

Measles was killing a couple million a year.

That's down to a few hundred thousand.

Anyway, this is a chart

where you want to get that number to continue,

and it's going to be possible,

using the science of new vaccines,

getting the vaccines out to kids.

We can actually accelerate the progress.

The last decade,

that number has dropped faster

than ever in history,

and so I just love the fact that

you can say, okay, if we can invent new vaccines,

we can get them out there,

use the very latest understanding of these things,

and get the delivery right, that

CA: I mean, you do the math on this,

and it works out, I think, literally

to thousands of kids' lives saved every day

compared to the prior year.

It's not reported.

An airliner with 200-plus deaths

is a far, far bigger story than that.

Does that drive you crazy?

BG: Yeah, because it's a silent thing going on.

It's a kid, one kid at a time.

Ninety-eight percent of this

has nothing to do with natural disasters,

and yet, people's charity,

when they see a natural disaster, are wonderful.

It's incredible how people think, okay,

that could be me, and the money flows.

These causes have been a bit invisible.

Now that the Millennium Development Goals

and various things are getting out there,

we are seeing some increased generosity,

so the goal is to get this well below a million,

which should be possible in our lifetime.

CA: Maybe it needed someone

who is turned on by numbers and graphs

rather than just the big, sad face

to get engaged.

I mean, you've used it in your letter this year,

you used basically this argument to say that aid,

contrary to the current meme

that aid is kind of worthless and broken,

that actually it has been effective.

BG: Yeah, well people can take,

there is some aid that was well-meaning

and didn't go well.

There's some venture capital investments

that were well-meaning and didn't go well.

You shouldn't just say, okay, because of that,

because we don't have a perfect record,

this is a bad endeavor.

You should look at, what was your goal?

How are you trying to uplift nutrition

and survival and literacy

so these countries can take care of themselves,

and say wow, this is going well,

and be smarter.

We can spend aid smarter.

It is not all a panacea.

We can do better than venture capital, I think,

including big hits like this.

CA: Traditional wisdom is that

it's pretty hard for married couples to work together.

How have you guys managed it?

MG: Yeah, I've had a lot of women say to me,

"I really don't think I could work with my husband.

That just wouldn't work out."

You know, we enjoy it, and we don't --

this foundation has been a coming to for both of us

in its continuous learning journey,

and we don't travel together as much

for the foundation, actually, as we used to

when Bill was working at Microsoft.