Jennifer Lewis, Head of Advocacy and Partnerships at Temasek Trust and Moderator: Welcome to Philanthropy Asia Summit. It's really a privilege to have the two of you here on stage, and it is a record turnout for us this year. I think we know why. Everyone's here to hear you and also to learn about how you are moving philanthropic capital—because we know that that's the capital that can tolerate the most risk, and the world is at risk.

It's a world where we are seeing rules—maybe all changed—trade flows affected, aid flows affected. So, if there was a mission you were on to solve one global challenge, what would it be? And if you had a hundred billion dollars, where would you place it?

Climate adaptation—Ravi would be happy. Nutrition—I know the Rockefeller folks would be very, very happy. Disease elimination—Gates has been with us on that. Global jobs crisis—you talked a lot about that as well, President Tharman.

What are the big bets and the trade-offs for philanthropy to step up?

President Tharman Shanmugaratnam, President of the Republic of Singapore and Distinguished Patron of Philanthropy Asia Alliance: Well, I have a little less experience in spending a hundred billion dollars than Bill has, so I will address the question differently.

We have a problem. There's a step change that's taking place in the global aid landscape. It's not just the US. It's the European countries, and more broadly, you add it all up together – even with China stepping up somewhat – there's a significant reduction in aid monies. And I don't think that’s going to change soon.

So we have to find ways in which this doesn't lead to catastrophe – greater global hunger, more epidemics, or other maladjustments and conflicts in the world.

It is possible to achieve this, but we've got to get more value out of every aid dollar spent.

We need a step up in resources – public sector resources within countries, philanthropic money, and private finance – but it’s not just about volumes, but effectiveness.

So if you think of how we can best deploy even a billion dollars, I think we first have to refocus on building up the domestic capacity within countries for them to be more self-sufficient. For sure, many will still require significant international support, through the multilateral development banks, through various bilateral schemes and through initiatives such as what we are trying to grow here.

But building up domestic tax capacity, building up the ability to execute budgets more effectively, is an extremely important challenge, and is doable. It's not a hopeless case at all. What many don't realise is that in the lowest-income regions of the world, several countries have significantly increased their tax revenues – by at least two to three percentage points of GDP, without loss to economic growth. It's doable.

But there's a capacity issue. There are, of course, political issues in some countries, but there’s a capacity issue. How can we digitise tax systems? How can we build more efficient administration of tax collection, and enforcement systems?

So that's a very important challenge, and there’s an interaction between the efforts that countries themselves make and the amount of support they're going to get internationally: from philanthropies, from the MDBs, from other governments that still are providing bilateral support.

Developing capacity within countries has to be a renewed priority. Besides tax administration, there are other areas. Gates Foundation, amongst others, has funded the African CDC. Excellent example, well run, with exceptional leaders. A good example of how countries in Africa have gotten together to develop capabilities of their own.

There are other examples to do with training people to reform health and agricultural systems – training PhDs, Master’s graduates digitising systems. There’s still huge potential for capacity development in Asia and in the developing world at large. It has to be a priority.

Jennifer Lewis, Moderator: Okay, we hear you then, President Tharman—build the capacity, and then we'll be ready for the challenges, whatever the challenge might be.

Bill—spending a hundred billion—to do good. You are the one with the most experience here on this stage. Where would you put it?

Bill Gates, Chair and Trustee, Gates Foundation: Yeah. So the Gates Foundation is celebrating its 25th anniversary. It was in the year 2000 when I first got started, and during those 25 years, we've given a little bit more than a hundred billion.

When we started out, we didn't know what impact we'd be able to have, and we saw some really awful things. You know, for example, because malaria was a disease only in poor countries, there was no work being done on malaria drugs or bed nets or any technique to reduce those deaths. When vaccines were first designed, they weren't cost-reduced. Vaccines like pneumococcus and rotavirus were so expensive, they were only going to children in rich countries—who were at almost no risk of dying of rotavirus—and over a million kids were dying of this diarrhoeal disease.

So we thought, okay, there's something that the market doesn't get. Because it's profit-driven, it does a lot of great things, but saving children's lives—it doesn't do well.

At the turn of the century, over 10 million children were dying every year who were under the age of five. And through not just us, but rich countries giving to things like Gavi, that bought vaccines, and the Global Fund, which worked on malaria, TB, and HIV—we’ve cut that child death rate from 10 million a year to below 5 million a year.

And so it's, you know, pretty phenomenal. Part of it is the R&D piece—of inventing new tools—and part of it is the delivery piece, and that's where the partners have been key.

You know, to eradicate polio, the world needs to spend another about $5 billion to get rid of that. To eradicate malaria—which is still killing 600,000 a year—we’ll need about $15 billion to do that.

Malnutrition is this evil thing that both makes you twice as likely to die—because you're just not as strong—and even if you do survive, your brain and your body never develop. And so 40 percent of kids in Sub-Saharan Africa don’t achieve their potential.

So I go against all of those things. In fact, I’m lucky enough that over the next 10 years, because we’ve grown, I’ll spend another hundred billion. But I would say—and the President made this point—you know, we could save lives for a few thousand dollars per life saved.

So if you buy bed nets, if you buy medicines for neglected tropical diseases—even a gift of a million dollars, or even less—can make a huge difference. Because the field of global health, even in the toughest countries, is now quite mature. We measure the outcome. We know what's working, what's not working. And we have a track record of success.

And so it's great—we're having some fellow philanthropists come together on health issues in this region, where people will be able to go and see the impact of their generosity.

Jennifer Lewis, Moderator: You know Bill, listening to you, I must say there's something I need to understand. You say it's your 25th anniversary, and anniversaries are full of celebration—a point of reflection and inflection—but this year has also been a year for some hard rethinks and resets for you. But you're full of optimism. Where does this optimism come from?

Bill Gates: Well, I would think of global health, which is the biggest area we work in. We work in agriculture and education and some other areas as well, but 70 percent of our money is in the research and the delivery of global health—because we saw such a tragedy and a market failure there.

I would divide global health into three eras. There's the last 25 years, with the great results. Then we have a period here which will last from four to ten years, where we have a lot less money. And some of these poor countries, particularly in Africa, are very indebted—and nobody's giving them the debt relief. So their financial situation is very, very weak.

And as was mentioned, the aid budgets—in the US, the tentative proposal is an 80 percent cut. We will go to the Congress and try to convince them to not be nearly that dramatic. But as Europe looks at its military spending and ageing society—and they’ve been the most generous, over twice as generous as other countries: Sweden and Norway in particular, but also France, Germany, the UK—we’re going to have a tough period here.

And the only reason that the deaths won’t go back to 10 million is that we do have innovative tools—and we have a pipeline of innovative tools. We have ways of protecting girls from getting HIV. We have new vaccines. We have an understanding of malnutrition. We have ways of stopping women from bleeding to death after delivery that only cost a few dollars in drugs.

So our teams come to Singapore and say, okay, let's find some of these research projects. Thank goodness for innovation—or else these funding cuts could drive us back almost to that 10 million a year. I’ll be an advocate that the idea of helping children survive and preventing HIV deaths is no less important today. And so this sort of wave of not caring for other countries—I feel it'll be reversed. At least, I’ll spend a lot of my time trying to make the case for that.

President Tharman Shanmugaratnam: To add to what Bill has said – and the thinking behind what you've been doing is very similar to our thinking in Singapore. We are faced with the shortage of development finance, and have to prioritise how it's going to be used. And apart from my point about building up capacity within beneficiary countries, we've got to deploy philanthropic and public monies as effectively as possible.

The approach you're talking about, and many of the examples you've been involved in like Gavi, have involved first investing in innovations, piloting them on a small scale to see what works, before then scaling up the interventions with proven impact. And I think that should be an important mindset in development funding – pilot, then scale up the proven interventions.

A reason for optimism is that it’s actually working very well. If you look at Gavi, just as an example, every dollar given to Gavi and spent by Gavi on proven interventions leads eventually to $54 of returns. By returns, I mean not just financial returns, but broader economic and social returns—healthier and more productive lives for everyone.

And that's actually the type of thinking – thinking about impact, and on the full returns on what we spend – that should motivate philanthropic giving and investments, as well as motivate the global public sector. We are doing this not just out of the goodness of our hearts. We are doing this not just because there is an important moral cause—but because we are all better off living in a world where every country has populations that lead healthier and productive lives. We are all safer, and we are all better off.

Jennifer Lewis, Moderator: Indeed, President Tharman. You know, each time we listen to you, each time we hear you, we are grateful that you are the patron of Philanthropy Asia Alliance. There's so much that needs to be done, and your wisdom has spurred us on. And we also know that—like Bill—you love innovation, and innovation in Asia is something you have told us repeatedly to be scaling, to be working hard on. Innovation, and what Asia can do for the world—what do you see of that?

President Tharman Shanmugaratnam: Well, there's lots that, again, Bill will have to say, and there's lots that many of you are already doing. The innovations that catch the news typically are about breakthroughs in technology, which are extremely important. We can come back to that—the potential for example for AI to enable a whole set of more effective social interventions, or better agriculture.

But innovation also involves organisation. For instance, if you look at India, one of the unsung successes is what they call the Aspirational Districts Programme. A well-chosen name for the most underdeveloped districts in India. This was Prime Minister Modi's initiative. I believe Gates Foundation joined Piramal Foundation and Tata Trusts in helping to fund it.

It gives ownership to the community—developing community health workers, para-nurses, and data systems, supported from the centre – targeted especially at maternal health and health of the child in the earliest years. Monitoring growth, month by month, monitoring nutritional intake, and making sure that circle of actions and remedies is closed at the local level. I've visited some of those districts, and seen how they are working because they give ownership and agency on the ground to the people in the village themselves—who know who the mothers are, who know who the absent fathers are, who know who the kids are who are a little smaller than others, and where something needs to be done to remedy that before they end up stunted. It's a very interesting example of innovation that can be of interest beyond India, elsewhere in the developing world.

Jennifer Lewis, Moderator: Asian solutions for the globe are just as important. Bill, you are in Southeast Asia. We know you are here on a very tight and busy schedule. Tell us what you're doing in Singapore, what you're going to be doing with Southeast Asia.

Bill Gates: Yeah, so I'm here for two days, but with a great agenda—seeing a lot of the leaders here. My Gates Foundation work is what I put the most time into, but I also do a lot of work on climate change through a group called Breakthrough Energy. And both of those organisations are very excited about what's going on in Singapore.

The Gates Foundation is putting an office here—to access the science, to partner with the philanthropic community.

Jennifer Lewis, Moderator: An office here in Singapore?

Bill Gates: Yes.

Jennifer Lewis, Moderator: Gates is opening an office here in Singapore? Thank you for that.

Bill Gates: Yeah, it's really to partner with philanthropists, to partner with the research being done here. Likewise, Breakthrough Energy has a very deep relationship with Temasek and a growing relationship with GIC. We've done things like fund innovative clean energy work through what we call our fellows programme. So I'll get to meet the first four of those, and that's a growing programme we're doing together with the top universities here.

I would say that Asian innovation is a part of why I am so excited about the progress we can make in health. Initially, when we thought of Asian innovation, we mostly thought about low cost—which is a great thing. I mean, the lowest cost vaccines in the world are made in India, Indonesia—this region.

But more and more, the innovation is about cutting-edge work. Genomics data that, when you combine it with AI, will help us understand what is the disease prevalence, what differences are there across all the diverse populations here. One of the scenarios we have for AI is that just talking to your phone in whatever language you use, you should get medical advice that's as good or better than you would get if you had a doctor with you all of the time. That health scenario will be enabled by AI.

The farmers in this region need advice about weather, which variety, and plant disease. We're piloting using the AI to give them advice where it’ll know about their soils and their land and what the pricing looks like. It's the innovation pipeline—a lot of which will be developed in this region—that means even with these aid cuts, although we will try and get them reversed, I do see even the toughest challenges like malaria, HIV—I do see us being able to solve those in the next 25 years.

Jennifer Lewis, Moderator: You know, Bill, we have to ask you to add dengue to that list. You talk about malaria, which is definitely very important. But within Southeast Asia, and really with the tropical parts of the world getting warmer, we're seeing dengue in other parts of the world as well. Will you add that to the solutioning as well?

Bill Gates: Yeah. We've been a big funder. We were the ones who funded this Wolbachia work down in Australia. That was a Gates Grand Challenge back in 2003. We jointly funded the work in Yogyakarta with an Indonesian family foundation who funded that rollout. That has benefited - It doesn't completely get rid of the dengue, but it drops the level pretty dramatically.

President Tharman Shanmugaratnam: —by about 70 percent.

Bill Gates: And we have some of our vaccine partners, including Sanofi and Takeda, who've worked on vaccines. We're going to need a next-generation vaccine to completely solve it. The dengue vaccine turns out to be quite challenging, but it is possible. We funded the early development of this mRNA, and so a lot of the new vaccines will be reformulated. And instead of using a needle, which a lot of people don't like, we're just going to have a little patch that you can self-apply. And it doesn't have any pain—or so we hope.

Whether it's just in general to get higher vaccination rates, or particularly in a pandemic, the fact that you could distribute this thing and just self-apply it rather than going into healthcare would be pretty dramatic. And so there's a lot of lessons coming out of the COVID pandemic that will help us with the current infectious diseases, but also would allow us to deal far, far better when—and sadly, it's not if, it's when—the next big pandemic challenge comes around.

Jennifer Lewis, Moderator: You know, we work very closely with the Gates team. So, you know, I'm sure dengue will be part of what's going on.

It sounds like we're asking for it, but it's something that we really go through quite a fair bit in Southeast Asia as well. It'll be great to see the malaria problem maybe broaden into a mosquito challenge for you.

Bill Gates: Yeah. For some of our diseases—it sounds awful to say this—but we're almost glad there's some cases in rich areas, like dengue in Singapore. I mean, it's a terrible thing to say. But, you know, it means that the priority for doing that—you know, HIV, it's tragic that it's everywhere. But part of the reason a lot of global health things like PEPFAR, Global Fund, they got created because the citizens in the US could see the tragedy of HIV. And when you said, should anyone in the world die just because we don't have the $100 a year to buy these ARV medicines? We managed, at least in that time, to get a strong bipartisan response to that. That's one of the things that's at risk, and we're going to have to re-explain to US politicians why they should stay engaged in that.

When you have a disease like malaria or malnutrition that's really only in the poor countries, then we really need to get people to come and see it. Of course, here in Singapore, the range of income levels and disease burdens just in the region is quite dramatic. You know— in Papua New Guinea—there's still some significant burdens. And of course, this is a region where we'd love to get rid of both dengue and malaria and have that be an example so the rest of the world can do the same thing.

Jennifer Lewis, Moderator: Indeed. Whatever we ask for through Philanthropy Asia Alliance, we ask not only for Singapore, but we ask for the region—because that's important to us.

Bill Gates: Fantastic.

Jennifer Lewis, Moderator: President Tharman, you know we've been following your speeches over the years around philanthropy as well. And really, it was at the inaugural PAS that you talked about the move—the need for that move—from cheque-book philanthropy to catalytic philanthropy. Have you seen philanthropists pick up on that idea?

President Tharman Shanmugaratnam: I think if you look at our new landscape of philanthropy, including the family offices, there's a generation of philanthropic leaders now who really want to see impact in what they're doing. And that impact is not completely dislodged from looking at financial returns, but they want more than that. They want to see social impact. They want to see a broader impact on the lives of beneficiaries.

So I think the thinking has shifted. And it's important now to develop the methods that allow us to measure impact so that—to go back to the earlier point—we can put more resources into proven interventions and scale them up.

Jennifer Lewis, Moderator: You know, when you speak of the shift in generation—and from what we are seeing through some of our efforts throughout the Temasek Trust ecosystem—we find it very interesting that the younger, well, not quite philanthropists, but maybe would-be philanthropists through their own wealth management platforms—they save, they invest.

Or at least when I was growing up, if I was savvy about my personal finances, I would save well, I would invest well, and that was what my platform was all about. We have found that the wealth platforms of today are including philanthropy in it—the young people whom they are trying to attract onto their apps, their wealth apps—are asking for philanthropy options to be part of it. Because they know to be savvy today in your personal finances is to give as well as to save.

So that's been an interesting shift that we've seen as well. But how do we get more, Bill, of the young people at least to see their $1 million, their $10,000, or even their $100 as making a difference? Not everyone moves a hundred billion.

Bill Gates: Yeah. Well, the Gates Foundation is trying to encourage philanthropy, both by people of great wealth—you know, we have a thing called the Giving Pledge that we have about 300 people who've committed to giving away the majority of their wealth during their lifetime or through their will. And so that's kind of a community.

But we also—you know, there's a day in the United States called Giving Tuesday, where we really talk about help your local teacher, help your local food bank, or help us succeed with polio eradication—where even $10 donations, you know, we say a bed net that protects a child, a vaccine that protects a girl from cervical cancer—that's actually $2 to buy that vaccine.

In the US, philanthropy is about 2 percent of the economy, so small compared to private sector and government, but globally it's about half a percent. And so the US is a little bit ahead on that. And it's interesting to think, okay, why is that? Is it the tax incentives? That may be part of it. Is it that we know the government can't solve all problems? And so there's this kind of self-reliance, local community groups—that's part of it.

We'd like to really spread this idea. A very big giving—you know, the most honourable givers are those who are actually making some sacrifice. And of course, when I give, I'm making no sacrifice at all. And so it's very praiseworthy. But helping people know that the money will be well used and they get a sense—I thought in the digital era, philanthropy would take off even more. As yet, we've only seen that in a very modest way.

And so I still believe we can do it, because we can connect the donor and have them see the outcome. We can't get everybody to go to the site of the actual work. And it's in those poor areas that the impact per dollar is dramatically higher. I'm not saying all philanthropy should be that, but that's—you know, I'm doing that with 90 percent of my resources.

In the US, about 5 percent of philanthropic giving leaves the country. So a lot of it is domestic, which is just fine.

President Tharman Shanmugaratnam: I think there's an important opportunity for philanthropy in this part of the world, which is moving beyond traditional charity towards addressing the largest problems that the region faces—and the world faces—through local action. And one of the least noticed large problems has to do with food systems and nutrition.

It's a looming crisis that isn't focused on very much because it's a slow-burning crisis. We have reached the limits of traditional ways of producing food – both by ordinary smallholder farmers as well as in industrial agriculture. We've reached the limits because it is too large a source of greenhouse gas emissions; we can't keep encroaching into natural forests and other natural ecosystems; and also because soil health has deteriorated very significantly.

In fact, there's been a step reduction in moisture in the soil over the last 20 years that now makes the land much more susceptible to droughts, much less able to be a sink for carbon, and much less able to grow plants with a reasonable yield. So we have a real challenge in how we grow food in future.

And on the demand side, we have the reverse. We have an explosion of demand.  We have about 1.7 billion people being added to the world’s population in the next 25 years. In fact, in the next 10 years, we have about 800 million people. And we have a much larger increase in food and nutrition demand – by some 50-75% over the next 25 years - because a large group of lower-middle-income people aspire to become middle class.

So food demand is going up. Supply is going to be constrained. We have to revolutionise food systems. We need a new Green Revolution—and a truly green revolution that uses less water, allows more moisture to stay in the soil, involves less methane emissions from rice cultivation especially, and less greenhouse gas emissions in general. And that still gives farmers a better yield.

And it's possible. One of the initiatives that Philanthropy Asia Alliance has launched is Decarbonising Rice. Using new seed varieties or new strains that are more resistant to droughts and floods. New cultivation techniques that use much less water. There have been large-scale trials now in India and elsewhere that have seen significant improvements in farmers' yields, a 50% reduction in water requirements, and 20-50% percent reductions in methane emissions.

So this is a large challenge. It involves all of us, because if we don't solve it, many more people in the world are going to go hungry in the years to come, and everyone else is going to see an increase in the cost of living, because food prices are going to go up. So we really need to focus on this – transform how rice is cultivated – in order that farmers can still have good incomes, populations can have good nutrition, including the poor especially, and the cost of living doesn't need to go up over time.

Jennifer Lewis, Moderator: Thank you, President Tharman. Bill, before we go—thank you for opening the office in Singapore. What do you want to see from this region, where innovation and philanthropy are concerned?

Bill Gates: Well, we're already seeing a lot of great philanthropists here. And I think people are very family-oriented. And so having something even beyond whatever the family business is—having the family philanthropy, getting the family members working together and being proud about what they're able to achieve—I think we're seeing a big increase in that. And so we're excited to be here and learn together.

Jennifer Lewis, Moderator: We're excited to have you here. Bill Gates, thank you. President Tharman, thank you very much. Ladies and gentlemen, thank you so much.