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It takes more than money to rid the world of a scourge such as polio - though having buckets of cash certainly helps. Also needed are ambitious thinking, organisational knowhow and the ability to bring new ideas to bear on old problems. These are also the kind of things that go into creating a successful technology company. This time around, though, Bill Gates the CEO has had to take a back seat to a less familiar persona: Bill Gates the diplomat.
要让世界根除小儿麻痹症这样的灾祸，光有金钱是不够的，虽然雄厚的资金必然是有益的。我们还需要深远的思考、组织技巧、以及用新理念来对付老问题的能力。这些也恰恰是用来创建一家成功高科技企业的要素。但这一次，首席执行官比尔•盖茨不得不让位于一个世人不太熟悉的人物：外交家的比尔•盖茨。
When the Gates Foundation made polio eradication a priority five years ago, the global anti-polio effort was running into the sand. More than 10 years of progress had given way, at around the turn of the millennium, to a stalemate as vaccination efforts in the countries still harbouring the disease failed to reach the coverage levels needed to push it into extinction. The organisations behind the existing drive - such as Rotary International, the business group that had long led the effort - “had sort of naively assumed it was on track, but it wasn't”, Gates says. “The idea that business as usual was going to get us there - it had to be broken out of that, because it wasn't going to succeed. It probably would have been better to just give up than do business as usual. But that would have been horrific.”
当盖茨基金会在5年前决定优先努力根除小儿麻痹症时，全球范围抗击这种疾病的努力正举步维艰。在世纪之交前后，当时已经进展10多年的项目在现实面前非常无力，那些仍存在小儿麻痹症病例的国家里，疫苗接种的覆盖尚未达到能根除疾病的水平。这些致力于该运动的组织，比如长期领导这一努力的商业团体“国际扶轮社”(Rotary International)“似乎有点天真地认为一切都在正轨上，但事实却并非如此。”盖茨说，“有人认为一切照常就会达到目标，但这不会成功，我们必须跳出这种想法。干脆放弃也许比一切照常更好，但那将是非常可怕的。”
Gates seems to relish nothing more than challenging business as usual, often by applying a dose of more ambitious thinking. It was the same impetus that led him to rethink familiar approaches to philanthropy, throwing his money into the urgent pursuit of solutions to big problems rather than attempting a drip-feed of donations that would amount to little more than a Band-Aid. While the foundations started by the likes of Howard Hughes and pharmaceuticals boss Sir Henry Wellcome are still among the handful of the world's richest decades after their founders' deaths, the Gates Foundation has been programmed to dole out all its cash and wind itself up 20 years after their deaths.
盖茨似乎最喜欢挑战“一切照常”，他经常为此展开更为深远的思考。同样的动力促使他反思人们熟悉的慈善做法，并最终决定把自己的大量财富花在为重大问题寻找解决方案这一紧迫任务上，而不是进行小打小闹的捐赠、到头来不能彻底解决问题。尽管霍华德•休斯(Howard Hughes)和制药业大佬亨利•惠康爵士(Sir Henry Wellcome)创立的基金会，在其创始人去世几十年后仍位居世界上少数财力极为雄厚的基金会之列。盖茨基金会则计划在盖茨夫妇去世后的20年内捐出所有资金，然后进入清盘程序。
The instinct to shake up the complacent and challenge the intellectually lazy doesn't always win Gates friends. Putting his personal money and reputation on the line to eradicate a disease has also risked accusations of vanity - a case of the “ego philanthropy” that can distort goals when the super-rich get involved. Wiping out a disease has only happened once before, when the World Heath Organisation declared in 1980 that smallpox had been eliminated. Helping to finance and organise a second eradication would cap the Gates Foundation's emergence as the most significant private charity in the world of global health. It would also set the stage for the next items on the list of diseases it hopes eventually to wipe out, starting with malaria.
撼动自满、挑战思维惰性的本能，并不总能让盖茨赢得朋友。为根除一种疾病而押上自己财富和声誉的做法，还有可能被人指责为“虚荣”——“自我慈善事业”指的就是这种情况。当牵扯到超级富豪时，这种慈善可能会扭曲目标。根除一种疾病的案例以往只发生过一次——世界卫生组织(WHO)在1980年宣布天花已被根除。若能帮助资助和组织根除第二种疾病，盖茨基金会将一跃成为全球健康领域最重要的私人慈善机构。此举还将为该基金会奠定基础，利于将目标转向其希望最终根除的其他疾病，为首的就是疟疾。
Gates brushes off questions about the merits of the eradication effort and whether other initiatives might be a better investment in terms of the immediate number of lives saved. “Eradications are special,” he says. “Zero is a magic number. You either do what it takes to get to zero and you're glad you did it; or you get close, give up and it goes back to where it was before, in which case you wasted all that credibility, activity, money that could have been applied to other things.”
有人质疑根除疾病努力的价值，认为若按被挽救之生命的直接数量来衡量，其他善举会不会是更好的投资。面对这些质疑，盖茨表示不屑。“‘根除’是一件很特别的事情。”他说，“零是一个神奇的数字。你要么尽一切努力来达到零，然后对自己实现了目标感到欣喜；要么在接近目标后放弃努力，然后发病率反弹至原有水平——在这种情况下，你白白浪费了大量信誉、精力和资金，而这些你原本可以投入到其他事业上。”
Since he threw his organisation behind the effort, polio has been eradicated in India. But it remains rooted in Afghanistan, Nigeria and Pakistan, spilling over sporadically into their neighbours. That these three countries remain among the world's most difficult to operate in - in Pakistan, the Taliban has taken to bombing vaccination teams, accusing them of being in cahoots with the CIA - provides a clue about why, nearly 30years after the eradication campaign began, polio persists. Eradication has little to do with making advances in science and technology - though work on new vaccines targeted more directly at the strains of the disease that remain has helped in the fight.
有赖盖茨基金会的支持，小儿麻痹症在印度已得到根除。但这种疾病在阿富汗、尼日利亚和巴基斯坦仍然流行，偶尔还蔓延到邻国。这三个国家仍是世界上最难开展慈善工作的，在巴基斯坦，塔利班曾对疫苗接种小组实施炸弹袭击，并指责他们与美国中央情报局(CIA)同流合污。这一事实实则说明了为什么在“根除”努力启动近30年后，小儿麻痹症仍然存在。能否根除疾病与科技是否取得进步关系不大，尽管在这一努力中，新疫苗（这些疫苗更直接地瞄准现存疾病类型）的研制工作起到了帮助作用。
Take one of the biggest challenges to managing immunisation campaigns against polio and other diseases in the developing world: getting vaccines to where they're required while keeping their temperature in a narrow 2C-8C range to prevent them spoiling. Running the so-called “cold chain” needed for this to happen - from big refrigerators in regional distribution centres to the cases vaccinators carry into the field - requires painstaking logistical organisation. Often, kerosene or other fuels used in refrigeration are in short supply or antiquated equipment fails due to lack of maintenance. According to Gates, problems like these are too low-tech to attract the world's best brains. “Unfortunately, it's a very mundane, practical thing,” he says. “It's not sexy from a scientific point of view.”
在发展中国家开展针对小儿麻痹症和其他疾病的免疫活动，最大的挑战之一是把疫苗运送到需要的地方，并在这一过程中确保它们的温度保持在2至8摄氏度的狭窄温度范围内，以防它们变质。要做到这一点，就需要所谓的“冷链”：从区域配送中心的大冰箱，到接种人员手中的接种箱。运营“冷链”需要进行周密的后勤组织。经常发生的情况是，制冷所用的煤油或其他燃料供应短缺，或者设备陈旧，年久失修出现故障。盖茨称，这样的问题技术含量太低，难以吸引世界上最优秀的大脑。“遗憾的是，这是一件很平凡、实际的事，”他说，“从科学的视角看，它不够‘性感’。”
A businessman's understanding of incentives helps. The number of fridges needed is not large enough to provide a profitable market for manufacturers so the foundation has had to make financial commitments in advance. The business model of the vaccine makers gives them little reason to lower their manufacturing costs to make their products more affordable, he adds. Their high costs are more than covered by prices they can charge in the developed world and any mistakes they might make as a result of tampering with their carefully regulated production processes would jeopardise that existing business. “That's not science - that's, how the hell do you make 50 cent vaccines?”
此时商人盖茨对激励机制的理解是非常有用的。由于所需的冰箱数量不够、不能为制造商提供一个有利可图的市场，盖茨基金会不得不预先作出财务承诺。他补充说，疫苗制造商的商业模式使得它们没理由降低生产成本、让自己的产品在价格上更合适。在发达国家能够开出的价格，足以覆盖它们的高成本。如果它们因改变自己精心调校好的生产工艺而酿成任何差错，那就可能危及现有业务。“这与科学无关——这个问题是，你如何才能制造50美分的疫苗？”
Management methods that would be immediately familiar to anyone involved in the fast-moving technology world are also being brought to bear. These include employing the rapid cycle of trial and error that new tech companies engage in before pouring money into a formula that works - a process known as “scaling”, which takes place as they race to capitalise on a new market before rivals emerge.
瞬息万变的科技行业的参与者所熟悉的管理方法也被引入。包括采用快速的试误周期——新的科技公司往往会先进行试误，然后再砸下重金将其中一种管用的设计方案投产，这个过程称为“规模化”，目的是让它们抢在竞争对手出现之前独占一个新市场。
Apoorva Mallya, a senior program officer who works on country implementation, puts the success in stamping out the disease in India partly down to pouring money into local initiatives that had the potential to be effective across the country, but which were being conducted on too small a scale to make a difference. These included assigning community mobilisers to individual districts and neighbourhoods before vaccination drives began in order to organise meetings of women and overcome distrust or resistance. “We went in and funded them for a massive expansion across India,” he says.
在国家层面负责实施的高级项目官员艾普瓦•马尔雅(Apoorva Mallya)认为，他们之所以能够在印度成功根除这种疾病，一定程度上是因为他们将大笔资金投向了地方性的项目；这类项目本已具备在全国有效实施的潜力，但因规模过小影响力不足，包括在疫苗接种活动开始之前向各区和街道指派社区动员者，由其组织妇女开会，克服不信任或抵制情绪。他说：“我们介入其中并提供资金，让他们在印度各地大规模推广。”
Another method familiar from the tech world involves more effective data collection and analysis. Vaccination drives fail if too many children fall through the net. To get a better understanding of effectiveness, the foundation has paid for teams of researchers to use statistical sampling to see if adequate coverage levels have been reached.
从高科技行业借鉴的另一种方法涵盖了更有效的数据收集和分析。如果有太多儿童“漏网”，疫苗接种努力就会失败。为了更好地掌握行动的效果，盖茨基金会资助了一些调研小组，用统计抽样来判断是否已达到足够高的接种率水平。
Measurement is also being brought to bear to build a more detailed understanding of how costs are incurred in vaccination drives. Without that data, it's hard to know where to focus attention to make global health programmes more effective, says Orin Levine, who runs the foundation's vaccination efforts. “We don't necessarily differentiate where the costs are in the system yet, so it makes it harder to say an innovation in [a particular area] will be something we really want,” he explains.
为了更细致了解疫苗接种项目的各项成本，盖茨基金会还引入了一些测算手段。负责该基金会疫苗接种工作的奥林•莱文(Orin Levine)表示，如果没有这些数据，就很难知道应当在哪里集中注意力，才能使全球健康计划变得更加有效。他解释说：“目前我们并未把整个系统中的各项成本都细列出来，也就是说很难说某一领域的某项创新是我们真正想要的东西。”
This kind of rigour would be familiar inside an engineering-centric company such as Microsoft, where rationality reigns. But in the more chaotic world of global aid, with its loose alliance of government agencies, NGOs and charities - many of them operating with only partial information - it does not pay to assume such disciplines. Learning to work in that world is one of the greatest adjustments.
在微软这种以工程为中心、理性至上的企业中，人们对这种严谨不会陌生。但在由政府机构、非政府组织和慈善机构组成松散联盟的全球援助领域，局面则更为混乱，很多机构是在仅掌握部分信息的情况下开展工作。在这样的环境中，要贯彻这样的纪律难免吃力不讨好。学会在该领域工作是盖茨作出的最大调整之一。
“The fact that people don't understand numbers and systems thinking and science and logic, that's OK,” Gates says - though his famous impatience might belie such a claim. “I only need a half of the people who contribute to really think in a way where I can say, hey, come on, there's a theory of change here, do you get it, do you get if that piece doesn't happen, it completely messes up that piece?”
“人们不理解数字和系统思维、不理解科学和逻辑，这没什么，”盖茨说——尽管他那出了名的不耐烦令我不敢全然相信他的这一说法。“我只需要一半参与者真正以合理方式思考，我可以说，嗨，这是变革理论，你要明白，如果不（按照变革的要求）去这么做，就会彻底搞砸。”
Like many self-made business people, Gates is wary about the ability of governments to deal with some of society's most pressing problems. Personal experience might have something to do with it. More than a decade ago, his fight with the US Department of Justice over whether Microsoft had acted illegally to defend its PC software monopoly ended in defeat, though a settlement with the George W Bush White House saved the company from the forced break-up that a judge had ordered.
与许多白手起家的商人一样，盖茨也担心政府应对某些最紧迫社会问题的能力。他的这种担心可能在一定程度上源自他的亲身经历。10多年前，他与美国司法部(US Department of Justice)围绕微软是否曾采取非法行动维护其PC软件垄断地位展开过较量，并最终成为战败的一方——尽管与小布什(George W Bush)政府达成的和解挽救了微软，幸免不必按照此前法官命令的那样强制分拆。
Gates describes himself as a natural optimist. But he admits that the fight with the US government seriously challenged his belief that the best outcome would always prevail. With a typically generalising sweep across history, he declares that governments have “worked pretty well on balance in playing their role to improve the human condition” and that in the US since 1776, “the government's played an absolutely central role and something wonderful has happened”. But that doesn't settle his unease.
盖茨称自己是一个天生的乐观主义者。但他承认，与美国政府之间的那场斗争严重挑战了他的信念，他原来一直相信最终胜出的总是最好的结局。他以一种典型的、归纳总结历史的语气宣称，政府“总的来说在改善人类生存条件方面很好地发挥了自己的作用”，在美国，自1776年以来，“政府发挥了绝对核心的作用，推动实现了一些壮举”。但是，这并没有缓解他的不安。
“The closer you get to it and see how the sausage is made, the more you go, oh my God! These guys don't even actually know the budget. It makes you think: can complex, technocratically deep things - like running a healthcare system properly in the US in terms of impact and cost - can that get done? It hangs in the balance.”
“你越接近第一线、看到腊肠是如何制作出来的，就越有可能说，天哪！这些家伙其实对预算一头雾水。你不由得会想：如果让他们去做些复杂的、在专业管理方面有点深度的事情，比如在美国运行一个有影响又具有成本管理的医疗系统，他们能够办到吗？这有点悬。”
It isn't just governments that may be unequal to the task. On this analysis, the democratic process in most countries is also straining to cope with the problems thrown up by the modern world, placing responsibilities on voters that they can hardly be expected to fulfil. “The idea that all these people are going to vote and have an opinion about subjects that are increasingly complex - where what seems, you might think... the easy answer [is] not the real answer. It's a very interesting problem. Do democracies faced with these current problems do these things well?”
问题不只是政府可能无法胜任相关任务。按照这种分析，多数国家的民主进程也在艰难应对现代世界带来的种种问题，让选民承担他们显然很难履行的责任。“有人主张，让所有人都去投票、就某些领域中日益复杂的课题形成一个意见——而在这些领域中，你也许会认为，那些貌似……容易的答案并不是真正的答案。这是一个很有意思的问题。面对当前这些问题的民主国家，在此类事情上做得到底好不好”
Compared with fixing the US healthcare system, the issues of global health and development taken on by Gates' foundation are, by his own estimate, relatively straightforward. But the work has required him to develop new skills: a willingness to engage with politicians and to develop reserves of diplomacy and persuasiveness. With more than 1,000 staff members and the ambition to shape the broad strategies directed at solving the problems it takes on, the foundation does much more than simply hand over money. It relies on partnerships with a wide range of government agencies and other bodies to have any effect - and that has forced Gates, the uncompromising and impatient tech leader, to apply the human touch.
按照他自己的估计，与修复美国医疗体系相比，盖茨基金会应对的全球健康和发展问题要更加直截了当。但这项工作要求他习得新的技能：培养与政界人士接触的意愿，修炼外交手腕和说服力的内功。盖茨基金会所做的远不只是发放资金，该基金会拥有1000多名工作人员，并立志要针对问题塑造整体上的解决战略。要想产生实际影响，它必须与各类政府机构和其他组织建立合作关系，这迫使盖茨这个不妥协和不耐烦的科技行业领袖学会跟人打交道。
Workers at the foundation say that he has been closely involved even at a regional and district level in winning the needed political backing. Gates, for instance, says he personally “bonded with” Nitish Kumar, the highly rated chief minister of the Indian state of Bihar, over the latter's strong backing for vaccination efforts.
基金会的工作人员称，盖茨一直密切参与争取必要政治支持的工作，甚至在区域和地区层面上也是如此。例如，盖茨说，他与印度比哈尔邦(Bihar)备受好评的首席部长尼蒂什•库马尔(Nitish Kumar)结下了很好的私交，以确保后者能够鼎力支持疫苗接种。
Sometimes in the field of global development, however, it is enough simply to be Bill Gates: the fame and wealth work their own magic. “If... I need to go to the Indian parliament and say, 'Let's get serious about vaccines,” then yes - since I'm giving my own money [on a] large scale and spending my life on it and I'm a technocrat - yes, that can be quite valuable.”
然而，在全球发展这个领域，有时仅仅做回比尔•盖茨就足够了：他的名气和财富会自动产生魔力。“如果……我需要去印度议会说，‘让我们认真对待疫苗接种工作’，那么没错——由于我拿出自己的大量财富、全身心地投入这项事业，而且我是个技术官僚——这一切可能相当有价值。”
If this brand of international development diplomacy has required new skills, however, some things haven't changed. Talk to almost anyone who has worked with Gates and they have a story about his intensity. On trips to the developing world his tirelessness wears out those around him. Inside the foundation, he shows the kind of endurance that once inspired and exhausted Microsoft product managers. “He wants to do the work with us at the most granular level. He will sit in four-hour meetings with us going over slide page after slide page,” says Raja Rao, who heads the foundation's work on perfecting the cold chain. “I've seen him sit in a room for 11hours non-stop just talking about technology, eating snacks and drinking Diet Coke.”
不过，如果说进行此类关注国际发展的外交活动需要习得技能，那么有些东西是一直没有改变的。曾与盖茨共事的人几乎都会谈到他对工作的高度投入。在前往发展中国家的旅途中，他马不停蹄让周围的人筋疲力尽。在盖茨基金会内，他展现出了曾经鼓舞（并且累坏）微软产品经理的那种耐力。“他要和我们一起做那些最琐碎的事。他会参加我们的4小时会议，逐页审阅幻灯片。”在该基金会负责冷链完善工作的拉贾•拉奥(Raja Rao)表示，“我见过他坐在一个房间里，连续11个小时不停地谈论技术、吃零食、喝健怡可乐(Diet Coke)。”
Many of the works on the bookshelves in Gates' office overlooking Lake Washington are scientific tomes on the diseases that he is combatting - of which, with characteristic diligence, he now has a deep personal understanding, according to others at the foundation. A voracious reader - he has always taken periodic breaks from his regular routine to read about and ponder the biggest problems he has taken on- his conversation is littered with references to authors. Given the smallest excuse, he plunges into a description of the different types of polio and vaccines - and then into the genetic tests that show how the disease once persisted and spread in areas like Uttar Pradesh even when full outbreaks were rare.
在盖茨俯瞰华盛顿湖的办公室里，书架上摆放着很多关于盖茨所抗击疾病的科学著作。据盖茨基金会的人介绍，凭借着标志性的勤奋，如今盖茨对这些疾病有了深刻的个人理解。盖茨是一个博览群书的人，他有一个保持了很久的习惯，那就是每隔一段时间暂时告别日常事务，专心阅读和思考自己选择应对的重大问题。他在谈话中也频频引用不同作者的观点。哪怕得到最小的由头，他也会滔滔不绝地介绍不同类型的小儿麻痹症和疫苗，然后又说，基因测试显示，这种疾病如何一度在印度北方邦(Uttar Pradesh)等地持续出现和传播，尽管极少有疫情全面爆发的情况。
This is the Gates who once ruled Microsoft with a command of detail and intellectual intensity that led to the kind of culture that was capable of dominating the tech world - even as it tipped over into behaviour that brought a regulatory backlash. “I was a kind of hyper-intense person in my twenties and very impatient,” he says. “I don't think I've given up either of [those] things entirely. Hopefully it's more measured, in a way.”
当年的盖茨正是凭借这样高强度的思维和对细节的掌握来领导微软的，它催生了能够主导高科技行业的那种文化——也催生了最终招致监管反弹的越线行为。“我在20多岁时是那种绷得非常紧的人，非常没有耐心。”他说，“我并不认为自己在这两方面已完全改变。只是希望自己变得更有分寸了。”
If the manner has mellowed, though, the uncompromising attitude is still very much in evidence. It is at once one of the strongest assets and one of the biggest hindrances in his plan to save some of the world's poorest from the fate to which a sometimes oblivious world has left them. Knowing how to pursue an unflinching personal logic without alienating people remains a work in progress for him.
不过，如果说盖茨的举止已变得更有分寸，那么他的不妥协态度可以说仍十分明显。盖茨的计划旨在拯救世界上一些最贫穷的人群，使他们摆脱这个有时对苦难视而不见的世界带给他们的命运。就该计划而言，盖茨的不妥协态度既是最强大的资产之一，也是最大的障碍之一。明白如何在不得罪人的情况下追求坚定的个人逻辑，对他而言仍是一种需要进一步修炼的内功。
“When we had a meeting a couple of years ago, when people weren't thinking through the polio thing very well, I was pretty critical,” he says. His message to the assembled workers: “'Hey, this is not good thinking, this is not good, this is not going to get us there.“”
盖茨说：“在两三年前的一个会上，当有关人员未能周密考虑根除小儿麻痹症的项目时，我的态度相当不客气。”他向与会工作人员传达的信息是：“这种思路可不行，它不够好，不能让我们达到目标。”
The new Gates, though, was not prepared to leave it at that. After the meeting was over, he did what husbands the world over are liable to do at such times: “I said to Melinda, was I too tough on that, who should I send mail to, was that motivational, de-motivational? It's all a matter of degree.”
不过，“新”的盖茨并没有打算不去想这件事了。会后，他做了世界各地的有家男人在这种时候都可能会做的事：“我对梅琳达说，我在这事上太严厉了吗？我应该给谁发封邮件？我的话是有激励作用还是让人泄气？这些全都是一个‘度’的问题。”
